Waveny Care Center ‘Has Suffered and Will Continue To Suffer Significant Harm’: Nursing Home Sues Healthcare Plan Provider
A Wilton-based company that specializes in healthcare plans and third-party administration services has violated its contract with Waveny Care Center by failing and refusing to provide documentation related to claims and payments made on behalf of the Farm Road facility’s employees, according to a lawsuit filed in state Superior Court in Stamford. According to a complaint filed on behalf of Waveny Care Center by attorneys Patrick Begos and Trevor Bradley of Stamford-based Robinson+Cole, the third-party company— Employee Benefits Solutions LLC or ‘EBS’—has failed and refused to to provide records demonstrating that claims had been processed appropriately, that approved claims had been paid in full, that service providers were paid using network reimbursement rates, among other areas. Those are areas of concern, according to the suit—first filed in July and scheduled for the court’s short calendar next week—in part because “Waveny has received numerous complaints and communications from employees, and/or employees’ healthcare providers, that providers did not receive payment for claims that EBS was contractually obligated to process and pay, and/or that EBS represented it had paid,” according to the complaint. “Some of these complaints countered claims that EBS had represented it had paid years ago. In some cases, healthcare providers have referred employees’ past-due balances to debt collectors and/or attorneys for collection.”
An attorney representing the defendant, Richard P. Colbert of Stamford’s Day Pitney LLP, could not immediately be reached for comment, though he has filed opposition materials on behalf of EBS (see below).