Danbury Hospital fights insurer's request to substantiate underpayment: 'Specific as it can be'

Rob Ryser, The News-Times, Danbury, Conn.News-Times

Aug. 4—DANBURY — Danbury Hospital will not revise the substance of a multimillion-dollar lawsuit it filed against UnitedHealthcare with extra details and specifications that the insurer has asked for in court, because the claim is perfectly clear as it is, the hospital says.

"(Danbury Hospital) is not sure how this can be made clearer for (UnitedHealthcare) to understand," says a document filed by a hospital attorney in state Superior Court. "There should be no confusion ... (the hospital lawsuit) is as specific as it can be."

Danbury Hospital, which recently became part of one of the largest health-care systems in the country, is objecting to a court request by UnitedHealthcare for the hospital to specifically document the cases where the insurer is accused of underpaying the hospital, and for the hospital to "plead some facts to support the spurious and unsupported allegation that United engaged in 'bad faith' to 'settle the claims for less than a reasonable person would have expected.'"

The hospital responded that it was not required disclose "all that the adversary desires to know in aid of his own cause" at this early stage in the legal dispute.

"[T]his request is simply erroneous and misguided," hospital attorney Timothy Butler says in a July 23 court document. "(T)he (hospital) has pled enough facts for the complaint to stand as is. ... A complaint need only contain a 'plain and concise statement of the material facts on which the pleader relies, but not of the evidence by which they are to be proved.'"

The hospital's refusal to bend to UnitedHealthcare's revision requests, except for two technical points, is the latest development in an underpayment case against the nation's largest health insurance company.

It comes just two months after hospitals in Danbury, Norwalk, New Milford and Sharon merged with a new parent company called Northwell Health, the largest health-care system in New York and a top 20 system nationwide.

Among other things, Northwell promised to invest $1 billion in its Connecticut hospitals over the next five years.

Danbury Hospital is seeking at least $1 million on each of four counts against UnitedHealthcare, along with punitive damages, legal fees and interest.

It will be up to a Superior Court judge to decide whether the hospital must comply with the insurance giant's request.

The hospital is not arguing that UnitedHealthcare can never see the evidence of underpaid claims that the hospital alleges, but rather that the time for evidence exchange is later in the pretrial process.

"Any further specifics would be evidentiary and are therefore proper matters for discovery," the hospital's attorney says.