Allegheny General Hospital Seeks Medicaid Beneficiaries’ Approval To Sue Insurer

Pittsburgh-based Allegheny General Hospital on Aug. 23 began sending letters to about 800 Medicaid beneficiaries, asking them to authorize hospital officials to sue a health insurance plan managed by UPMC Health System for $3 million in unpaid claims, the Pittsburgh Post-Gazette reports. Allegheny General claims that Best Health Care refused to pay for care that Medicaid beneficiaries received over the last three years. Best Health Care paid for some of the claims but not the full amount, according to Jerry Fedele, general counsel for West Penn Allegheny Health System, Allegheny General's parent company. The letters were sent to beneficiaries whose claims were denied, asking them either to agree to let the hospital to sue UPMC or to pay the bills themselves. "We suspect the vast majority of people will sign the letter, send it back and we'll continue to pursue [the case against UPMC]," Fedele said. For its part, UPMC said that Allegheny General was not a "participating provider" in its health plan network and did not have an agreement with Best Health Care on a Medicaid rate schedule. UPMC officials said they paid Allegheny General the amount mandated by Pennsylvania for medical assistance claims (Gannon, Pittsburgh Post-Gazette, 8/27).