Treatment center says Sanford authorized care, then didn't pay bills

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A California substance abuse center is seeking more than $1.2 million from Sanford Health Plan, arguing the insurer has failed to pay for treatment that it covers for its insured members.

New Life Treatment Center filed suit against Sanford in federal court late Thursday.

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The company says that it provided treatment to patients covered by Sanford after Sanford verified patient benefits and authorized New Life to provide services. In communications between the two entities, Sanford agreed to pay New Life both before and after services were provided to Sanford’s covered members. Those charges were based on usual, customary and reasonable (UCR) rates for services, or, in other cases, based on contracted rates.

“But Sanford has not paid these claims as promised,” New Life’s complaint says. “For some claims, Sanford has paid only a fraction of billed charges or a UCR amount. For other claims, Sanford has paid nothing at all.”

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