ROCHESTER, MN (trfnews.i234.me) — Mayo Clinic has filed a civil lawsuit against Sanford Health Plan, seeking $739,956.20 in unpaid medical expenses. The lawsuit, filed on December 13, 2024, in Olmsted County District Court, alleges that Sanford Health Plan breached its contract by failing to cover costs for a patient hospitalized in Rochester, Minnesota.
Patient Transfer and Insurance Details
The patient, referred to as C.G. in court documents, was transferred on February 5, 2022, from CHI Saint Alexius Health in North Dakota to Mayo Clinic Hospital for intensive care. At the time of transfer, Sanford Health Plan was listed as the primary insurer, with Blue Cross Blue Shield North Dakota Medicaid as secondary coverage. Mayo Clinic contacted Sanford Health Plan to verify eligibility and obtain preauthorization for the patient’s care.
Authorization and Subsequent Denial
On February 8, 2022, Sanford Health Plan authorized inpatient admission for five days and subsequently approved all days of care until the patient’s discharge on March 29, 2022. Sanford Health Plan also paid some claims during the hospitalization. However, on April 15, 2022, Sanford informed Mayo Clinic that the actual payer was a tribal plan administered by Sanford, identified as the Three Affiliated Tribes Tribal Health Plan, designated as a “payer of last resort.” Sanford requested Mayo Clinic to refund the payments and bill Blue Cross Blue Shield (BCBS) North Dakota as the primary insurer. Mayo Clinic complied and refunded the payments. When Mayo Clinic billed BCBS, the claims were denied due to lack of preauthorization.
Legal Allegations
Mayo Clinic alleges that Sanford Health Plan’s misrepresentation as the primary insurer and subsequent retraction prevented Mayo from obtaining necessary preauthorization from BCBS, resulting in unpaid medical bills totaling $739,956.20. The lawsuit includes claims of breach of contract, promissory estoppel, and negligent misrepresentation.
Current Status
Sanford Health Plan has filed a motion to dismiss the complaint and stated that it does not comment on active litigation to protect confidentiality and respect the legal process. The lawsuit has been moved to the U.S. District Court of Minnesota, with a pretrial conference scheduled in Minneapolis on February 4.
I’m Chris Harper, reporting for trfnews.i234.me