Westside Behavioral Care Inc., a Colorado mental health clinic, recently sued Kaiser Foundation Health Plan of Colorado for prematurely terminating its participation agreement. Kaiser terminated the agreement in an effort to increase the provision of services through a less costly telehealth model.
The clinic is alleging that the early termination disrupted care for more than 7,800 patients, in violation of continuity of care requirements. Law and regulations are in place to ensure that patient care is not disrupted when a provider terminates its network participation with a payor and patients with only in-network (HMO-like) benefits are forced to find new providers to continue the care.
The mental health clinic is alleging millions of dollars in damages, due in part to loss of revenue from services it would have provided but for the push to telehealth. Kaiser, in turn, has claimed that the clinic overcharged Kaiser by more than $5 million.
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