Its members are suing two of the region's largest health insurers, claiming each tried to weasel out of paying for millions of dollars in patient care.

In the latest suit, filed last week, the Brooklyn-based Brookdale University Hospital and Medical Center accused the 1.3 million-member Health Insurance Plan of Greater New York of engaging in an illegal conspiracy to routinely reject valid claims.

Brookdale's chief executive, David Rosen, said the managed care company refused to pay for more than 1 of every 5 days its patients spent at the hospital last year. Often, those rejections were on the grounds that the treatment was not medically necessary.

The lawsuit said many of those denials were baseless, and it cited the example of one patient who spent 11 days at Brookdale after having surgery for a malignant brain tumor.

The gravely ill woman suffered from brain swelling and organ failure and was fed through a tube during her hospital stay. But, according to the lawsuit, the HMO ultimately refused to pay for her final eight days of care, saying "the patient was medically stable.''

Source: N.Y. Hospital, Upset Over Claims Denials, Accuses HMO of Racketeering


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