Here we go it starts and this goes back to the 2% sequester decrease that is being passed along. As we all know hospitals are struggling to survive as they have a number of fixed costs that can’t be reduced. The article didn’t say if the 2% sequester cuts were also passed along to doctors or not. BD
A group of Western Pennsylvania hospitals has sued health insurer Highmark Inc. and a subsidiary for reducing payments to them, causing what the hospitals say are “significant economic damages.”
The lawsuit, filed on Monday in Allegheny County Common Pleas Court, claims Highmark and Keystone Health Plan West have been improperly shorting the hospitals 2 percent of Medicare Advantage reimbursement payments since Jan. 1, violating the terms of their contract. The hospitals want a judge to order the insurer to pay back the money it withheld. An audit would determine the amount.
Highmark, the state's biggest health insurer, is the largest provider of Medicare Advantage plans in Western Pennsylvania, where it has about 150,000 members.
Under Medicare Advantage, an alternative to traditional Medicare, the federal government contracts with private insurance companies to administer Medicare benefits to seniors.
Central Pennsylvania's Susquehanna Health System filed a similar lawsuit against American Progressive Life and Health Insurance Co. of New York in July.
It is not clear how many insurers have passed on the 2 percent to health care providers.
The hospitals filing suit include independent hospitals Butler Memorial, Conemaugh Valley Memorial, Indiana Regional Medical Center, Jameson Memorial, Miners Hospital, Meyersdale Community, St. Clair Memorial, Washington Hospital and Windber Medical Center and three Excela Health hospitals: Frick, Latrobe Area and Westmoreland Regional.
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