Bright Health on the hot seat—again—as SSM Health sues for $13M in unpaid claims

The hits keep coming for embattled insurtech Bright Health Group.

Earlier this month, Oklahoma health system SSM Health filed suit against the insurer in federal court, alleging that it owed nearly $13.1 million for 2,541 unpaid claims incurred for services provided to its members between Jan. 1, 2020, and Feb. 7, 2023.

SSM said in the lawsuit that it has provided more than $15.6 million worth of services in total to Bright Health plan members across facilities in three regions. However, due to ongoing business challenges, Bright Health was under investigation by Oklahoma regulators and exited its Affordable Care Act exchange in December 2022.

SSM said it was not in a contract with Bright Health to offer discounted services in exchange for network access.

"Because the parties do not have a contract, Bright is not entitled to discounted payment rates for the medical services provided by SSM to its enrollees, but instead is responsible for the reasonable and customary charges billed by SSM," the health system said in the complaint.

Bright Health is also under investigation by insurance regulators in Tennesee, Texas, Colorado and Florida, the lawsuit noted.

This lawsuit could start a trend as Bright Health unwinds its ACA exchange business. Ari Gottlieb, a consultant at A2 Strategy Group who tracks the insurtech industry, previously referred to the company as a "walking disaster" that could not pay out claims it owes.

A spokesperson for Bright Health countered that claim, saying the company "continues to actively pay claims in each of the markets it is exiting.” Should other providers encounter similar issues to SSM, however, further legal action is likely to follow.

In addition to the messy exit from the exchanges, Bright Health has struggled with the newfound pressure of being a publicly traded company after its initial public offering in mid-2021 set a new record for insurtech valuations

The company's stock has traded at under $1 for months and was selling for 17 cents per share late Wednesday morning. The low stock values have led to the New York Stock Exchange to threaten the insurtech with a stock delisting.

Bright Health also revealed on its fourth-quarter earnings call earlier this year that it overdrew its credit, and that the company would need to raise $300 million by the end of April to stave off bankruptcy.