Provider Law Likely Heading Back to Court

by Mark Friedman  on Monday, May. 5, 2008 12:00 am  

Lynn Weaks, CEO of Arkansas Surgical Hospital in North Little Rock, says the 41-bed facility won't be able to survive long term without higher reimbursement rates.

"After our first year 'in network,' we have noticed a considerable reduction in our reimbursement per case," Weaks wrote.

He said he thought that AWP "requires that insurers offer the same rates, discounts and/or methods of reimbursement to providers of the same class."

Weaks also said that he learned that the payments were not the same as other hospitals in the area.

"We believe that the 'AWP Law' is not being fully complied with and that we and many, if not most, other providers are being paid in a discriminatory manner," Weaks said. "We believe that Arkansas consumers are at risk to have their choices limited because of these discriminatory payments practices."

Weaks said the letter was a formal complaint against QualChoice, Arkansas Blue Cross & Blue Shield and United HealthCare of Arkansas, the three largest health insurance carriers operating in Arkansas.

ABCBS spokeswoman Max Heuer said any willing provider didn't have anything to do with rates.

"The any willing provider law was passed to deal with network access, not payment rates," she said.

Heuer said it's up to the hospitals to decide if they want to take the rates offered by the insurance companies.

"Our position is we want to try and keep costs affordable for our members," she said.

Other states with AWP laws also don't think the law has anything to do with rates.

"We don't consider rates or payment methodology as part of any willing provider," said Ronda Sloan, a spokeswoman for the Kentucky Office of Insurance. In April 2003, Kentucky's AWP got a seal of approval from the U.S. Supreme Court, paving the way for Arkansas' AWP law to go into effect.

Sloan said Kentucky insurance regulators occasionally do, however, receive complaints from hospitals regarding reimbursement rates.



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