Dive Brief:
- Nine Florida hospitals operated by Nashville, TN-based HCA Holdings are suing Molina Healthcare of Florida over the HMO's refusal to reimburse them for more than $88 million in expenses for emergency services, reports the Daily Business Review.
- The hospitals argue Molina is required to pay the expenses because of a Florida law that stipulates HMOs are to cover out-of-network costs for their members' emergency medical care.
- The hospitals involved in the lawsuit say they provided emergency care to more than 3,000 Molina members while Molina excluded them from its network for its ACA marketplace plans in 2014 and most of 2015.
Dive Insight:
The hospitals say Molina reimbursed them for $13.6 million of the $102 million out-of-network emergency expenses provided to its members in a case that experts say highlights one of the issues in the trend of narrow network health plans. They note in the first years narrow and "exceptionally narrow" plans began exploding in popularity, issues existed around patients being able to access accurate network information and understand whether they were going out-of-network.
Miami healthcare attorney Douglas Wolfe told the Miami Herald similar disagreements are being watched across the country and he expects courts rather than politics to find the resolutions.
The nine Florida hospitals in the lawsuit are Kendall Regional Medical Center; Miami Beach Healthcare Group; Plantation (Fla.) General Hospital; JFK Medical Center; Westside Regional Medical Center; Plantation Palms West Hospital; West Palm Hospital; University Hospital and Medical Center; and Northwest Medical Center.