Provider, Insurer Both Lose Motions Seeking Summary Judgment

Mealey's (February 18, 2021, 2:34 PM EST) -- SAN JOSE, Calif. — Allegations that a surgery provider made phone calls confirming insurance coverage and received a letter confirming benefits create questions about whether a contract exists between it and an insurer which would obligate payment at 70 percent of the usual and customary rate, but the provider has not eliminated questions about the legitimacy of a money had and received claim stemming from alleged overpayment on one of the benefits claims, a federal judge in California said Feb. 12 in denying two motions for summary judgment....