Lawsuit Asking Insurance Company To Pay For Remote Appointments Moves To Federal Court

Humana Health Plan, Inc., Humana, Inc., and Humana Insurance Company, are defendants in a lawsuit alleging that they engaged in breach of fiduciary duties, breach of contract, and violated numerous laws when they failed to compensate American Kinetics Lab, Inc. (AKL). The case, originally filed in the New York State Court in March, was moved to federal court on Monday and is currently held in the New York Eastern District.

The plaintiff alleged that the defendants have an outstanding balance of $102,832.52, which it did not pay because the appointments were completed remotely. Through the lawsuit, the plaintiffs are seeking an order demanding compensation from Humana and an order awarding punitive damages, costs, attorney’s fees, and disbursements. 

Humana, a health insurance company, provided coverage to individuals who were patients of the plaintiff from August of 2020 to October of 2020. As a durable medical equipment provider, the American Kinetics Lab provides medical equipment like hinged knee braces, suspension sleeves, and back braces to its patients. In October 2020, an internal audit at Humana prompted the company to send a notice to AKL that there would be no coverage for that time frame whatsoever because “there is no proof of the patients physically receiving consultations by the physicians.”

This notice from Humana prompted statements from the plaintiff about the defendant’s engagement in “reckless breaches of fiduciary duties to and contractual obligations with the plaintiff.” AKL countered with a statement that had been released by the Department of Health and Human Services Centers for Medicare & Medicaid, where they explained that “due to the switch to remote operations, physicians may inhibit innovative uses of technology and capacity to operate their practice.” Due to the COVID-19 pandemic, appointments were allowed to take place virtually and thus the plaintiff was under the impression that all consultations and appointments had taken place “following the legal guidelines set by the law.”

AKL further alleged that Humana was continuing to “retroactively deny,” all other insurance claims that were sent to them. They explained that despite being legally mandated to fulfill the insurance claims, the defendant has still not paid the plaintiff, even in light of the plaintiff’s continued efforts to get into communication with the defendant regarding payment. 

The plaintiff maintained its statements that Humana has “retained the benefits of Plaintiff’s services without just compensation” by breaching their existing contract, unjustly enriching themselves, violating general business laws, and breaching their fiduciary duties. As a result, the plaintiff is seeking compensation, punitive damages, costs, attorney’s fees, disbursements, and other fees deemed necessary by the court.

The plaintiff is represented by Sinayskaya Yuniver, and the defendants are represented by Kaplan Johnson Abate & Bird.