Tennessee Medical Association Urges Supreme Court to Help Emergency Physicians Challenge Underpayments

 

October 12, 2016

NASHVILLE – The Tennessee Medical Association filed an amicus curiae brief with the Tennessee Supreme Court today asking the court to hear the appeal of a case involving the rights of hospitals, emergency room physicians, and other healthcare providers to challenge underpayments made by health plans for out-of-network emergency services to patients covered by commercial health insurance. 

The case, filed in Tennessee state court by Hospital Corporation of America against BlueCross BlueShield of Tennessee, seeks several million dollars in damages for the alleged underpayments of emergency medical services in some of HCA’s Tennessee hospitals. Although a hospital case, TMA believes the ultimate decision will impact Tennessee emergency room physicians and other physicians’ rights to challenge health plan underpayments. 

Some of the alleged underpaid claims involved claims governed by ERISA plans. Before the Court of Appeals’ decision, healthcare providers had important and well-articulated rights under state law to pursue underpayments.

If the Tennessee Supreme Court does not accept the appeal and reverse the Court of Appeals’ decision, TMA anticipates more and more physicians will be negatively affected. Healthcare providers will be forced to pursue such challenges only in federal court under federal law, where the rules are less specific and otherwise designed to favor the health plans. There are even some circumstances in which healthcare providers may not have the right to file a federal court action, essentially leaving them with no rights at all. 

As narrow networks proliferate for both employer-sponsored health plans and exchange plans for individuals and small groups, it could increase the number of underpayment scenarios and affect even more physicians.

TMA’s brief focuses on the how the court’s decision impacts TMA members and their patients.

“TMA is going to bat for emergency room physicians, patients, and any other physicians who balance bill patients because they are underpaid by health plans,” said TMA President Dr. Keith G. Anderson, a cardiologist in Memphis. “The increased use of narrow networks by health insurers is just going to make this problem worse, and Tennessee physicians need to be able to challenge underpayments of claims in state court. This case is the vehicle to be able to accomplish that goal.”