PROFESSIONFlorida hospital that says HMO paid too little can sueA state appellate court leaves open the question how much insurers must pay out-of-network doctors and hospitals for emergency services under state law.By Amy Lynn Sorrel, amednews staff. Sept. 4, 2006. Winning the first round in what doctors and hospitals hope to be a larger victory, Florida's 5th District Court of Appeal ruled that physicians and hospitals can take their payment disputes to court under a state law that requires HMOs to pay noncontracted health care professionals for emergency treatment they give patients who belong to the network. The decision underscores doctors' long-running battle in the state to compel insurers to reimburse them promptly and fully for emergency services that federal law obligates them to provide. Doctors are praising the ruling, which they say helps them clear the first hurdle to getting reimbursement relief. "This decision finally resolved the biggest question as to whether or not doctors have the right to sue, and it provides a redress for physicians who, in the past, had to basically accept whatever the HMO wanted to pay," said John M. Knight, general counsel to the Florida Medical Assn., which joined a friend-of-the-court brief supporting the hospital, along with the AMA/State Medical Societies Litigation Center and three other medical groups. If the appeals court ruling stands, the case will return to a trial court to open up the larger question at the crux of the dispute -- the amount that Blue Cross Blue Shield of Florida is required to pay out-of-network Adventist Health System. The hospital, which operates seven facilities in the Orlando area that are not a part of the Blue Cross network, sued the Blues plan under the state's emergency services statute, saying the health plan did not reimburse the hospital for the full charges it billed. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2006 American Medical Association. All rights reserved.
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The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment. Meeting coverage - Slideshow Feature articlesHealth reform review The Massachusetts experience Litigation stress Being sued is personal as well as professional Comprehensive coverage
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