Central Wyoming’s only dedicated cancer center is at risk of having to shut down over a nearly $2 million dispute with an insurance company.
That’s according to a lawsuit filed in Natrona County District Court on Friday by Rocky Mountain Oncology Center (RMOC), which claims health insurer Mountain Health Co-Op (MHC) is refusing to pay for $1.9 million in patient coverage as a result of past overpayments the insurer claims it made to the Casper and Lander center.
Mountain Health, which is based in Helena, Montana, argues that it actually overpaid RMOC for services in 2023-2024 and now shouldn’t have to pay for its patients’ coverage until that alleged overpayment has been covered.
In the complaint filed Friday, RMOC’s attorney Frank Chapman says if forced to forgo receiving the $1.9 million, the health care facility may have to stop providing cancer treatments to patients. RMOC is the only dedicated cancer center in Natrona and Fremont counties, and provides services for 11 types of cancers.
RMOC says it could be forced to close its locations in Casper and Lander if uncompensated for the future care due to the expensive nature of cancer treatments.
“MHC’s decision to unilaterally offset payments on unrelated claims jeopardizes RMOC’s ability to continue providing critical cancer treatments to Wyoming residents,” Chapman writes in the lawsuit.
RMOC claims that it’s received zero evidence from Mountain Health about the supposed overpayments that were made besides a link to a nonexistent webpage.
An attorney for Mountain Health told Cowboy State Daily he couldn’t comment as he hadn’t been served with the lawsuit yet or seen it.
What’s It About?
In a letter sent to RMOC in July, Utah Health informed RMOC on behalf of Mountain Health it had overpaid in the sum of $1.9 million over the past two years and would attempt to withhold reimbursements on future clients.
Utah Health said if it did not receive this reimbursement within 60 days, it would refer the debt to the Utah Attorney General’s Office for collections.
“A refund is now being requested since there have not been enough incoming claims to clear the balance,” the letter reads.
No evidence was provided with the letter to back up the claim or after RMOC tried to get more information from Mountain Health. The insurance company acknowledged this in a letter, apologizing for the abrupt notice it gave and saying, “Unfortunately, communication on these audits was not as transparent as … preferred.”
Under RMOC’s provider agreement, it will honor purchaser requests for refunds on overpayments made within one year of the overpayment date, but needs an appeal filed to do so. Unilaterally choosing to not pay for future payments is not an option under RMOC’s policies.
On Sept. 3, RMOC sent a cease-and-desist letter to Mountain Health after Mountain Health had already withheld $300,000 in payments for claims unrelated to the debts it says its owed. The company has indicated it plans to continue withholding payment until fully compensated for the $1.9 million.
Chapman said in the Friday filing this total now exceeds $350,000.
What Do They Want?
In its court filing, RMOC claims Mountain Health has committed breach of contract, breach of implied duty of good faith and fair dealing.
It’s seeking a declaratory judgment and preliminary injunction requiring Mountain Health to resume making payments for client services. RMOC also requests relief for monetary damages it may have suffered as a result of Mountain Health’s actions.
Leo Wolfson can be reached at leo@cowboystatedaily.com.
