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I hope to see ED pay improve with this and future court wins
Court rules insurers underpaid ED docs
- Thread starter Airborne Flt Doc
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Arkansas Court Rules that Health Insurer Centene Systematically Underpaid Emergency Room Doctors Affiliated with TeamHealth
(KNOXVILLE, Tenn.) August 20, 2020 – A federal court in Little Rock, Arkansas yesterday found that health insurer Centene Corporation and its affiliates have wrongfully and intentionally underpaid frontline providers at Southeast Emergency Physicians (SEP), a TeamHealth affiliate, since 2014. The jury found Centene, Ambetter and Novasys liable for $9.4 million in underpayments to frontline emergency physicians, the full request made by TeamHealth. These insurance reimbursements allow SEP providers to treat patients across Arkansas and keep the doors open at critical emergency rooms in the midst of a pandemic.
“Today’s ruling is a win for frontline providers heroically risking their lives treating patients during the deadly COVID-19 pandemic,” said TeamHealth CEO Leif Murphy. “Centene’s actions are all too common on the part of payors. Large and profitable health insurance companies are using their market power to systematically underpay doctors, cancel contracts, and further boost their record profits. Even in the face of extortive, punitive and collusive pricing behavior by health insurers, TeamHealth has remained committed to keeping patients out of the middle of billing disputes.”
The court found that since 2014, Centene-controlled insurance companies and health networks have only paid the SEP clinicians 20% of the amount owed. Centene’s Arkansas networks have continued to systematically underpay the clinicians of SEP during the COVID-19 pandemic while reporting record profits of $1.2 billion during the second quarter of 2020.
“As emergency room clinicians, we treat every patient regardless of their ability to pay,” said Dr. Stan Thompson of Southeast Emergency Physicians. “Many can’t pay and we depend on commercial plans like Centene’s to pay fair rates to cover the cost of the emergency department safety net. If all commercial plans pay at the level Centene tries to pay, I will not be able to recruit a single qualified emergency room physician to practice in Arkansas. After three years of pursuing Centene for underpayment, it is a relief to finally have a jury hear our case and vindicate our position that Centene, and not the patient, is responsible for fair payment for emergency services. My hope is that Centene, Ambetter and Novasys will now honor the court approved rates so that their members can have peace of mind when they need emergency care during the pandemic and beyond.”
TeamHealth and its affiliates have filed more than 25 lawsuits across the country to stop large health insurers from underpaying emergency department physicians. In June, a Federal District Court in Nevada ruled that TeamHealth's racketeering lawsuit against health insurer UnitedHealthcare can proceed. TeamHealth alleges that UnitedHealthcare breached its contract by underpaying claims and working with a third-party claim administrator to artificially reduce the payment rates that frontline physicians depend on.
“TeamHealth is confident that the court system will continue to rule against health insurance companies that engage in serial underpayment,” said TeamHealth CEO Leif Murphy. “While TeamHealth’s primary goal in every case is to obtain in-network contracts at reasonable rates
as soon as possible, we are prepared to take cases to trial as we are confident that our position will be vindicated by a jury.”
(KNOXVILLE, Tenn.) August 20, 2020 – A federal court in Little Rock, Arkansas yesterday found that health insurer Centene Corporation and its affiliates have wrongfully and intentionally underpaid frontline providers at Southeast Emergency Physicians (SEP), a TeamHealth affiliate, since 2014. The jury found Centene, Ambetter and Novasys liable for $9.4 million in underpayments to frontline emergency physicians, the full request made by TeamHealth. These insurance reimbursements allow SEP providers to treat patients across Arkansas and keep the doors open at critical emergency rooms in the midst of a pandemic.
“Today’s ruling is a win for frontline providers heroically risking their lives treating patients during the deadly COVID-19 pandemic,” said TeamHealth CEO Leif Murphy. “Centene’s actions are all too common on the part of payors. Large and profitable health insurance companies are using their market power to systematically underpay doctors, cancel contracts, and further boost their record profits. Even in the face of extortive, punitive and collusive pricing behavior by health insurers, TeamHealth has remained committed to keeping patients out of the middle of billing disputes.”
The court found that since 2014, Centene-controlled insurance companies and health networks have only paid the SEP clinicians 20% of the amount owed. Centene’s Arkansas networks have continued to systematically underpay the clinicians of SEP during the COVID-19 pandemic while reporting record profits of $1.2 billion during the second quarter of 2020.
“As emergency room clinicians, we treat every patient regardless of their ability to pay,” said Dr. Stan Thompson of Southeast Emergency Physicians. “Many can’t pay and we depend on commercial plans like Centene’s to pay fair rates to cover the cost of the emergency department safety net. If all commercial plans pay at the level Centene tries to pay, I will not be able to recruit a single qualified emergency room physician to practice in Arkansas. After three years of pursuing Centene for underpayment, it is a relief to finally have a jury hear our case and vindicate our position that Centene, and not the patient, is responsible for fair payment for emergency services. My hope is that Centene, Ambetter and Novasys will now honor the court approved rates so that their members can have peace of mind when they need emergency care during the pandemic and beyond.”
TeamHealth and its affiliates have filed more than 25 lawsuits across the country to stop large health insurers from underpaying emergency department physicians. In June, a Federal District Court in Nevada ruled that TeamHealth's racketeering lawsuit against health insurer UnitedHealthcare can proceed. TeamHealth alleges that UnitedHealthcare breached its contract by underpaying claims and working with a third-party claim administrator to artificially reduce the payment rates that frontline physicians depend on.
“TeamHealth is confident that the court system will continue to rule against health insurance companies that engage in serial underpayment,” said TeamHealth CEO Leif Murphy. “While TeamHealth’s primary goal in every case is to obtain in-network contracts at reasonable rates
as soon as possible, we are prepared to take cases to trial as we are confident that our position will be vindicated by a jury.”
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LOL. the article is written by someone who doesn't understand the **** show that EM docs face. Teamhealth just pocketed $9M. I know exactly how much will hit the bank accounts of TH clinicians from this suit... scroll down.
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$0.00 GTFO
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$0.00 GTFO
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This is an impressive game of smoke and mirrors between publicly traded-companies trying to appear less sleazy than the other. This month. Next month I'm sure Team will be back in the defendant chair.
And while this circus continues to keep us plebeians entertained, rest assured the board members of both companies are up late at night pondering how to best customize the herringbone pattern of the upholstery in their next Bentley.
And while this circus continues to keep us plebeians entertained, rest assured the board members of both companies are up late at night pondering how to best customize the herringbone pattern of the upholstery in their next Bentley.
