News

Texas hospital district calls for stricter ‘prompt pay’ rules

By Ryan Smith 18 Jun 2020 - Originally posted on insurancebusinessmag.com

The Knox County (Texas) Hospital District (KCHD) is calling for legislative reform that would restore Texas’s “prompt pay” requirements on the insurance industry.

KCHD has a pending complaint at the Texas Department of Insurance (TDI) against Aetna US Healthcare to get payment on more than $12 million in claims going back to 2017. KCHD also had a dispute with Blue Cross Blue Shield, which it said stopped making reimbursement payments in 2017. That dispute ended with Blue Cross Blue Shield being slapped with a $10 million fine.

The hospital district said that violations of the Texas Prompt Pay statutes are systemic, and have “forced healthcare providers into an endless loop of filing complaints at TDI and pursuing legal action simply to get paid for services rendered.” KCHD has also called on state lawmakers to demand that TDI take a more aggressive stance on enforcing existing prompt pay laws.

“It has been almost 20 years since Texas adopted its historic prompt pay measures,” said Stephen Kuehler, CEO of KCHD. “In the ensuing decades, insurance carriers have used a variety of means to steadily erode the enforcement of this critical measure, which ensures that rural hospitals like ours get paid in a timely fashion. Our proposed Prompt Pay Protection measures are much needed for critical-care providers like Knox County, which is the only hospital available to the residents of our county.”

Kuehler called on the Texas Legislature to close loopholes in the Prompt Payment statutes currently in the Texas Insurance Code, and said that TDI was the best agency to enforce the rules.

“The COVID-19 pandemic has further exposed just how vulnerable our rural healthcare system is, and we are already reaching out to other rural providers and look forward to working collectively with TDI to get this situation fixed in 2021,” Kuehler said.

 

Knox Co. Hospital District promotes ‘prompt pay,’ battle with insurance companies continue

Deanna Watson, Wichita Falls Times Record NewsPublished 4:04 p.m. CT June 17, 2020 | Updated 4:06 p.m. CT June 17, 2020

The Knox County Hospital District submitted a Prompt Payment Protection proposal to the Texas Department of Insurance in anticipation of the upcoming session of the Texas Legislature.

The hospital district, in a publicized battle with insurance companies in alleged unpaid reimbursements, said in a statement received Wednesday that violations of the Texas Prompt Pay statues "are now systemic and have forced healthcare providers into an endless loop of filing complaints at TDI and pursuing legal action simply to get paid for services rendered. KCHD has also called on state leaders to demand that TDI take a more aggressive stance in existing prompt pay laws."

Knox County is about an hour southwest of Wichita Falls and 80 miles north of Abilene. The district has claimed Blue Cross Blue Shield of Texas has not paid more than $21 million in insurance claims. A Texas district judge in the fall of 2019 ordered BCBS of Texas to pay the insurance claims reportedly owed to the Knox County Hospital.

Some 23 Texas legislators, including Rep. James Frank, were recently sent a letter requesting intervention in getting the TDI to enforce the Texas Insurance Code Prompt Pay statute.

Knox County Hospital District had sought help from the Texas Department of Insurance in getting $12 million in alleged unpaid claims from Aetna U.S. Healthcare, a fight the hospital says goes back nearly two years. The hospital district has a pending complaint at TDI against Aetna, a release in May 2020 stated.

"It has been almost 20 years since Texas adopted its historic prompt pay measures. In the ensuing decades, insurance carriers have used a variety of means to steadily erode the enforcement of this critical measure which ensures that rural hospitals like ours get paid in a timely fashion,” Stephen Kuehler, KCHD CEO, said. “Our proposed Prompt Pay Protection measures are much needed for critical care providers like Knox County, which is the only hospital available to the residents of our county.”

Administrative changes to the code would restore the original intent of the prompt pay requirement, the release stated.

“We are grateful that TDI has solicited provider input as it makes plans for the 2021 Texas Legislature,” Kuehler added. “The COVID-19 pandemic has further exposed just how vulnerable our rural healthcare system is and we are already reaching out to other rural providers and look forward to working collectively with TDI to get this situation fixed in 2021."

Violations to the Prompt Pay statue, said Kelly Dawson, attorney for the Knox County Hospital District, have become routine in Texas.

“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 hold Aetna accountable,” Dawson said. “If they don’t, we will have to spend more time and money in the courts just to get paid for services provided.”

The Knox County Hospital District provides healthcare services for residents of Knox County and surrounding areas. The Knox County Hospital is a 25-bed acute care critical access facility located in Knox City, Texas.

A message was left with the Aetna's corporate marketing department before deadline. The Times Record News will update with any response.

 

KNOX COUNTY HOSPITAL DISTRICT SUBMITS 2021 PROMPT PAY PROTECTION PROPOSAL FOR TDI CONSIDERATION

FOR IMMEDIATE RELEASE

June 17, 2020

KNOX COUNTY HOSPITAL DISTRICT SUBMITS 2021

PROMPT PAY PROTECTION PROPOSAL FOR TDI CONSIDERATION

(June 16, 2020) – The Knox County Hospital District (KCHD) has submitted a Prompt Payment Protection proposal to the Texas Department of Insurance (TDI) to consider supporting as the state agency tasked with regulating the insurance industry has begun formulating it’s 2021 agenda for the 2021 session of the Texas Legislature.

Knox County, which has a pending complaint at TDI against Aetna U.S. Healthcare to get payment on more than $12 million in claims going back to 2017, said that violations of the Texas Prompt Pay statues have become systemic and have forced healthcare providers into an endless loop of filing complaints at TDI and pursuing legal action simply to get paid for services rendered. KCHD has also called on state leaders to demand that TDI take a more aggressive stance in existing prompt pay laws.

we have come to the conclusion that it is imperative that the Texas Legislature address loopholes in the Prompt Payment statues currently in the Texas Insurance Code. Attached is a summary of our proposals which we think would help restore the original intent of the prompt pay requirements.

“It has been almost 20 years since Texas adopted its historic prompt pay measures. In the ensuing decades, insurance carriers have used a variety of means to steadily erode the enforcement of this critical measure which ensures that rural hospitals like ours get paid in a timely fashion,” Stephen Kuehler, KCHD CEO, said. “Our proposed Prompt Pay Protection measures are much needed for critical care providers like Knox County which is the only hospital available to the residents of our county.”

“We are grateful that TDI has solicited provider input as it makes plans for the 2021 Texas Legislature,” Kuehler added. “The COVID-19 pandemic has further exposed just how vulnerable our rural healthcare system is. We are already reaching out to other rural providers and look forward to working collectively with TDI to get this situation fixed in 2021.

“I have no doubt that healthcare will be front and center in 2021,” Kuehler said. “Rural providers better be at the table or we’re going to be left out.”

According to Kelly Dawson, attorney for the Knox County Hospital District, the current situation with Aetna demonstrates how routine violations of the Prompt Pay statue have become.

“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 hold Aetna accountable,” Dawson said. “If they don’t, we will have to spend more time and money in the courts just to get paid.”

Recent reports have indicated that many of the state’s rural providers have no more than 30 or 60 days of operating funds in reserve and strict enforcement of the Prompt Pay laws (which require payment within 60 days) is a critical consideration.

About Knox County Hospital District:

Knox County Hospital District provides healthcare services for residents of Knox County and surrounding areas. The hospital district offers a wealth of medical services, including 24-hour emergency care, advanced radiology services, a clinical laboratory, physical therapy, patient education and more. The Knox County Hospital is a 25-bed acute care critical access facility located in Knox City, Texas which is 78 miles north of Abilene. The District also operates two rural health clinics, an outpatient retail pharmacy, home health, emergency medical services (EMS), a nursing home and durable medical equipment (DME) services.

Knox County Hospital Seeks State Intervention to Force Aetna U.S. Healthcare to Pay $12 Million in Past-Due Debts

Insurance Giant is Over Two Years in Arrears to Rural Healthcare Provider
{Reprint Wichita Falls Times-Record News}

By Deanna Watson,
Wichita Falls Times Record News
June 6, 2020

Nearly two months ago, the Knox County Hospital District sought help from the Texas Department of Insurance in getting $12 million in alleged unpaid claims from Aetna U.S. Healthcare, a fight the hospital says goes back nearly two years.

Knox County Hospital, about 90 miles south west of Wichita Falls, filed a complaint with TDI in March, according to a release the hospital district dated April 7, 2020, to compel Aetna to pay more than $12 million in unpaid claims dating back to June 2018.

The plea to the TDI has not resulted in a resolution, the hospital district stated, and now representatives formally urged legislators, including North Texas Rep. James Frank, to step in. (Read full story here.)

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 ASKING STATE LEADERS, TDI TO COMPEL AETNA TO PAY PAST-DUE BILLS IT OWED

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.”

{See full release here}

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.”

BLUE CROSS BLUE SHIELD $10 MILLION FINE DESERVES FURTHER SCRUTINY

(Wichita Falls, TX, March 10, 2020) – 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.”

TDI found that BCBS fleeced providers and its subscribers by claiming computer errors on numerous issues. The Commissioner’s Conclusions of Law were:

  1. “BCBSTX has engaged in unfair and deceptive acts or practices in the business of insurance by making a statement misrepresenting the policy terms and benefits, pursuant to TEX. INS. CODE. §541.051(a) by including incorrect messages...”
  2. “BCBSTX failed to notify some Blue Advantage Plus members of the procedures for contacting BCBSTX if the member received a balance bill for out-of-network emergency care...”
  3. “For many clean claims subject to EBM review, BCBSTX failed to comply with the applicable prompt payment timelines set forth...”
  4. “...BCBSTX violates TEX. INS. CODE. §843.252 because it did not maintain records...”
  5. “...BCBSTX violated TEX. INS. CODE. §4201.206 AND 28 Tex. Admin Code §19.1703(b)(26) because it failed to afford the provider of record a reasonable opportunity to discuss the plan...”

The conduct the Commissioner sanctioned BCBS for is in lockstep with the unlawful conduct exhibited by BCBS against Knox.

BCBS stopped making reimbursement payments to Knox County Hospital in June of 2017. It wasn’t until October of 2017 that the company finally responded to inquiries by claiming it was a computer glitch. Knox County Hospital continued to treat Blue Cross Blue Shield subscribers and submit claims. Blue Cross Blue Shield continued to withhold reimbursement.

“We have pursued every avenue available to us since Knox County has been victimized by every one of the tactics the state has now found Blue Cross guilty of,” Dawson said. “I have no doubt there are other rural hospitals who are also being bullied by this company.”

Knox County Hospital filed a lawsuit against BCBS in State District Court in September 2019, after repeated complaints to the Texas Department of Insurance yielded no action. The case is now headed into court ordered arbitration. An attempted mediation last week failed to produce a settlement.

Last year a State District Judge issued a Temporary Restraining Order, which included the following findings of fact:

  • Blue Cross Blue Shield has willfully and wantonly undertaken acts to secure funds which do not belong to them;
  • Blue Cross Blue Shield engaged in slanderous activities;
  • Blue Cross Blue Shield willfully and wantonly breached a duty of care;
  • Blue Cross Blue Shield willfully and wantonly violated the Insurance (regulations) of the

    state of Texas;

  • The Court deems these acts to be willful conduct of fraud.

    BCBS then filed a motion to have the case moved to federal court and then filed a motion to have the entire lawsuit sent to mediation. The parties failed to reach an agreement in mediation;

    In a retaliatory move, BCBS subsequently dropped Knox County Hospital from its network, despite the fact that Knox County is a critical access facility and the only health care provider in the county.

    Last month the Knox County Hospital was named to the nation’s Top 100 list for Rural and Community Hospitals – the second time it has been honored as one of the nation’s elite rural facilities in the last four years.

    ###

    About Knox County Hospital District:

    Knox County Hospital District provides healthcare services for residents of Knox County and surrounding areas. The hospital district offers a wealth of medical services, including 24-hour emergency care, advanced radiology services, a clinical laboratory, physical therapy, patient education and more. The Knox County Hospital is a 25-bed acute care critical access facility located in Knox City, Texas which is 78 miles north of Abilene. The District also operates two rural health clinics, an outpatient retail pharmacy, home health, emergency medical services (EMS), a nursing home and durable medical equipment (DME) services.