Texas Supreme Court Rules Against Medicare HMOs in Hospital Reimbursement Fight

Sound like a move in the direction of getting rid of some additional red tape in the claim process...BD

AUSTIN, Texas, Aug. 31 /PRNewswire/ -- The Supreme Court of Texas has ruled that hospitals providing Medicare-related services can seek reimbursement in state court without first being forced to pursue costly and time-consuming reviews through "the federal administrative machinery." "This is a huge victory for health care providers," says attorney Scott Clearman of Houston-based McClanahan & Clearman, who represents five area hospital systems in their case against Hartford, Conn.-based Aetna Inc. . "It's not often that the Texas Supreme Court rules against insurance companies. More important, this decision puts a little more certainty in the health care system and that's good for everyone.

However, the Texas Supreme Court found that "requiring Hospitals to exhaust administrative remedies before coverage decisions have been made would turn the administrative scheme on its head ... "
The Court reversed the court of appeals decision and remanded the case to the trial court to determine Aetna's contractual obligations to the hospitals.