PSJ nursing home sues AIG

March 03--PANAMA CITY -- A Port St. Joe nursing home has filed a federal lawsuit alleging a multinational insurance company refused to pay for the care of one of its elderly patients because the treatments were not "medically necessary," according to court records.

LP Port St. Joe LLC, doing business as The Bridge at Bay St. Joe, filed the complaint Dec. 29 in the U.S. District Court for the Northern District of Florida in Panama City against American International Group Inc., more commonly known as AIG, citing the Employee Retirement Income Security Act.

Bay St. Joe is asking for a jury to return all benefits owed, interest, all legal fees and any other relief as the court deems just. Their attorneys have demanded $233,000 in relief.

In its complaint, Bay St. Joe claims that between 2009 and 2012, the business suffered damages from not being paid for the medical claims made on behalf of a patient covered under AIG's plan. The patient's name was not revealed for purposes of confidentiality. Bay St. Joe said in 2010 that the patient's Medicare benefits had become exhausted, making his coverage through AIG the primary insurance coverage.

For the remainder of his treatment, the patient was supposed to be covered by AIG. But despite billing AIG throughout the course of treatment, Bay St. Joe allegedly only received a handful of payments in 2011 and no payments in 2012, the lawsuit states.

Since the patient was discharged, Bay St. Joe has not received any back payments.

"Ultimately, (AIG) contended that the medical care and treatment that it had failed to pay for was custodial," the lawsuit states, "meaning that it could be performed by personnel with no clinical training whatsoever, and was therefore not medically necessary. Despite several level of appeals, (AIG) would not reverse its decision."

AIG is an American multinational insurance corporation with more than 88 million customers in 130 countries. As of 2015, AIG companies employed about 65,000 people.

AIG has been ordered to file an answer to the complaint by March 13. Representatives with the company did not respond to a request for comment.

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