BLUE CROSS BLUE SHIELD ORDERED TO PAY $108.3 MILLION OWED
TO PAIR OF NOW-CLOSED RURAL TEXAS HOSPITALS
Bankruptcy Court Filings Reveal that BCBS Violated Texas Prompt Pay Statues;
Texas Department of Insurance Took No Action
A huge judgement was made against Blue Cross Blue Shield of Texas from the U.S. Bankruptcy Court, Western District in Waco on May 12.
The causes of actions and claims are nearly identical to those made by the Knox County Hospital District against Blue Cross Blue Shield. And, as with the Knox County case, the Texas Department took no action on behalf of these central Texas hospitals even though an arbitrator has now found BCBS to be in violation of Texas Prompt Pay Statues and the Texas Insurance Code.
Knox County Hospital District wants Texas Department of Insurance to Investiage a Claim Aetna U.S. Healthcare has not paid $12 Million in Billings
"The Knox County Hospital District wants state leaders to demand that the Texas Department of Insurance (TDI) investigate a claim Aetna U.S. Healthcare has not paid $12 million in billings owed to the Knox County Hospital. Knox County Hospital, about 90 miles south west of Wichita Falls, filed its complaint with TDI in March..." Wichita Falls Times Record News
KNOX COUNTY HOSPITAL ASKING STATE LEADERS, TDI
TO COMPEL AETNA TO PAY PAST-DUE BILLS IT OWES
The Knox County Hospital District is calling on the state leaders to demand that the Texas Department of Insurance (TDI) investigate its claim against Aetna U.S. Healthcare for more than $12 million in past-due billings owed to the Knox City Hospital. Knox County filed its complaint with TDI last month in an effort to compel Aetna to pay more than $12 million in unpaid claims dating back to June 2018.
“Aetna is clearly in violation of the Texas Prompt Payment statute. These are clean claims that have gone unpaid for two years. TDI, as the regulatory agency for the healthcare insurance industry, needs to do their job and hold Aetna accountable,” said Kelly Dawson, attorney for Knox County Hospital District. “In this national Crisis, the Governor calls upon all health care facilities to remedy this crisis. Without question health care providers have risen to the task to which they probably never assumed—tasks and sacrifices which will go untold.”
“We are asking state leaders to ask TDI to make our complaint against Aetna a priority,” said Knox County Hospital Administrator Stephen Kuehler. “We can’t wait any longer. These cases go back two years and we need the funds today.”
Texas Rural and Community Hospitals Can Help Texas Address COVID-19 Crisis
As Texas, like the rest of the country, comes to grips with the likelihood that the COVID-19 pandemic means most communities will face overwhelming demand on our healthcare delivery system, state leaders should consider utilizing a long-neglected asset to help address the crisis. Texas rural and community hospitals are ready and capable of being a valuable contributor to the state’s response to the corona virus crisis.
Gov. Abbott said as much in his Sunday press conference, noting the role that Texas rural hospitals could and should play in addressing the coming pandemic as the state sent out its all-hands-on deck call. But for rural and community hospitals to contribute fully, the state must make plays today to include them in the contingency funding plans being put in place for an anticipated shortage of hospital capacity in the next 30 or 60 days. READ MORE
KNOX COUNTY HOSPITAL DISTRICT
BLUE CROSS BLUE SHIELD $10 MILLION FINE DESERVES FURTHER SCRUTINY
Attorneys for Knox County Hospital say the state’s $10 million fine of Blue Cross Blue Shield (BCBS) for mishandling out-of-network emergency claims and providing incorrect information to consumers demonstrates that a much broader review of BCBS is merited. The Texas Department of Insurance (TDI) announced Friday that the fine reflects that there were significant issues including violation of the state’s prompt payment statute. The insurance giant was also ordered to pay restitution to consumers harmed by its actions. BCBS has agreed to pay the fine within 30 days and complete restitution payments by the end of the year. This agreed to TDI’s order after TDI conducted a market conduct examination on BCBS from January 1, and ending in September 30, 2018.
“There is no doubt other entities that have been harmed by this chronic callous treatment. Clearly, the pattern of behavior by BCBS merits a broader review by TDI,” said Kelly Dawson attorney for Knox County Hospital. “BCBS owes Knox County Hospital more than $20 million in unpaid claims. Although we are seeking relief in federal court, the state remains responsible for regulating BCBS” added Dawson. This is the same pattern of conduct TDI found BCBS in violation of. As cited by the order, BCBS has a system programming error which caused the issues. This is not unlike what was told to Knox.”
Innovative approach helps hospital survive & thrive
While the state of Texas continues to lead the nation in rural hospital closures, the Knox County Hospital was named as one of the 2017 Top Rural Hospitals in the United States. The hospital has greatly expanded services, including providing lab services for hospitals outside of Knox County. In addition to operating a 14-bed, non-profit, acute care facility serving the county and surrounding areas, the Knox County Hospital District operates two rural clinics, a pharmacy, nursing home and other ancillary services.
The District also owns and operates Knox County Retail Pharmacy, Munday Nursing Center, and Seymour Medical (DME). Whether your healthcare needs are urgent or chronic, we welcome you to experience compassionate and personalized care provided by people you know.
As your hometown healthcare team, the District offers many services designed to improve community health and wellness and include Inpatient, Swing Bed, Level IV Trauma Center, Laboratory, Radiology, Physical Therapy, Cardiac Rehabilitation, Speech Therapy, Knox County EMS, Home Health, and 2 Rural Health Clinics.
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- After Bitter Closure, Rural Texas Hospital Defies The Norm And Reopens
- Texas must address rural hospital closures
- Taking the pulse of Texas hospitals, revenue is up, but rural care is down
- ‘How Can You Do This to People?’
- Texas A&M report examines rural communities facing hospital closures
- When Rural Hospitals Close, More Than Health Care Is Lost
- Rural, For-Profit Hospitals Closing at an Alarming Rate