A Greenburgh medical practice that was paid $546 for medical services that were billed for $53,449 is suing to get back the balance of the bills.
T.V. Seshan M.D. P.C. seeks to enforce arbitration rulings that found that it was entitled to 96% of the original bills, according to two lawsuits filed this month in U.S. District Court in White Plains, instead of the 1% that was covered.
T.V. Seshan employs neurologists who specialize in monitoring patients during surgical procedures.
In June 2023, a neurologist monitored a spinal surgery at MidHudson Regional Hospital, Poughkeepsie. T.V. Seshan submitted health insurance claims totaling $19,817 to the patient’s health care insurers, BlueCross BlueShield Association and Anthem Blue Cross Blue Shield.
The insurers paid $162.93.
Also in June 2023, a neurologist monitored a surgery at Buffalo General Medical Center and T.V. Seshan billed Highmark Blue Cross Blue Shield Western New York for $33,632.
The insurer paid $383.43.
In both instances, T.V. Seshan was an out-of-network provider and its services were not covered by the patients’ health insurance plans.
But under the federal No Surprises Act, the complaints state, medical services that are provided emergently or inadvertently must be reimbursed.
T.V. Seshan had 30 days to negotiate a settlement, then if the disputes were not resolved it had the right to ask for a neutral arbitrator to determine the proper reimbursements.
A year ago, arbitrators ruled in favor of T.V. Seshan, awarding the medical practice a total of $50,592.
The health care insurers did not pay the arbitration awards, according to the complaints. So now T.V. Seshan is asking federal court to confirm the arbitration awards and direct the insurers to pay $50,592 .
Spokespeople for Anthem and Highmark said in emails that the insurers do not comment on pending litigation.
