STAT+: In a fight over denied claims, HCA sues out-of-state Blue Cross Blue Shield plan — SkimNews
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- HCA Healthcare hospitals in Texas filed suit against Independence Blue Cross seeking more than $345,000 in unpaid medical claims dating back roughly four years.
- Independence Blue Cross, a large Philadelphia-based Blue Cross Blue Shield plan, is accused of denying claims that the HCA hospitals say were medically necessary.
- The dispute spotlights the contentiousness of prior authorization and the varying standards insurers use to determine whether care qualifies as medically necessary.
- Providers, patients, and policymakers have condemned insurers for using prior authorization to cut costs and increase profit, and some have called for a ban on the practice.
- The lawsuit also offers a window into the high prices HCA hospitals charge Blue Cross plans for patient care.
- Health insurers have responded to the criticism with voluntary pledges to scale back prior authorization requirements.
Why it matters: This lawsuit attaches a dollar figure to a fight over how insurers define medically necessary care — a process that directly affects hospital revenue and delays patient treatment. For HCA, litigating even a $345,000 dispute over denied claims shows the chain is willing to take Blues plans to court rather than absorb denials as a cost of doing business.
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