Hospital pursues litigation to secure reimbursement from commercial insurer

Client(s) Hospital system

Jones Day represented a hospital system bringing suit against a large health plan, contending that the hospital had provided services to over 2100 patients who were plan members and the plan had wrongfully failed to pay the contracted rates the parties had agreed upon. The plan argued that it was wholly unresponsible for a large portion of the claims at issue where the plan had operated as a “third party administrator.” On behalf of the hospital, Jones Day brought a motion for partial summary judgment arguing that the parties’ agreement encompassed services provided to such patients, and that the plan was otherwise liable for the wrongful denials, which included alleged downcoding, level of care/medical necessity disputes, and administrative denials. After a hearing, the court granted Jones Day’s client’s motion. The Court subsequently granted additional motions in limine Jones Day filed on behalf of its client, while denying several of the health plan’s motions that Jones Day’s client opposed. The case then resolved shortly prior to scheduled trial.