This Broward hospital is suing Florida Blue over emergency care. Here’s why
The ongoing dispute between Broward County’s public hospitals and Florida Blue has escalated, with one of the hospitals suing the health insurer over allegations that it has refused to pay or underpaid the hospital for providing out-of-network emergency care and services.
Broward Health, which is one of the largest public hospital systems in the country and primarily serves northern Broward, is asking the court to decide how much Florida Blue, formerly known as Blue Cross Blue Shield of Florida, is required to pay for the out-of-network and “medically necessary” emergency care provided to Florida Blue members.
The health system says it wants the health insurer to pay up, with 12% interest per year, for the out-of-network emergency care provided to Florida Blue members since the health system went out-of-network in July, according to the complaint filed last month in Broward circuit court. The suit says that the “amount in controversy exceeds $750,000, exclusive of interest, costs and attorneys fees” and involves emergency claims filed for care provided to patients who have commercial health plans through Florida Blue, including from the ACA marketplace.
“Florida Blue does not comment on pending litigation,” Jorge Martinez, a spokesman for the health insurer, told the Miami Herald on Wednesday. Broward Health did not immediately respond to a request for comment.
What led up to the lawsuit
Florida Blue is one of the largest health insurers in the state and provides coverage to one-third of the state’s population. Like most health insurers, it’s required by law to cover emergency care at Broward Health and other ERs at in-network rates, even if the emergency room is out-of-network. However, while ER doctors decide the necessary treatment, health insurers are the ones that ultimately determine whether the provided services fall under emergency care for in-network rates.
But Florida Blue “has either denied the claims in question (in whole or part) or paid the claims in part” but has done so “at rates below both Broward Health’s billed charges and the usual and customary provider charges for similar services in the community in which they were rendered,” according to the lawsuit.
Court records show that Florida Blue has until May 14 to file a response against Broward Health’s complaint.
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The argument is similar to the one Broward Health and Memorial Healthcare System, the public health system that primarily serves southern Broward, have been making throughout their ongoing and lengthy contract disputes with Florida Blue. The hospitals have accused Florida Blue of underpaying them compared to similar South Florida health providers and insurers. Florida Blue has accused the Broward hospitals of wanting too much money.
The disputes, which began last year, have dragged out for an unusually long time and left thousands of people locked out of in-network care at the public hospital systems. All three continue to say that they are working to reach a deal.
