|By Kenneth Hart, The Daily Independent, Ashland, Ky.|
|McClatchy-Tribune Information Services|
KDMC and its affiliates last week filed a motion in
The suit also names the state Cabinet for Health and
In its motion to intervene, filed by attorney Allison Brown Vermilion of
The move "further weakens Coventry's illegally anemic provider network in eastern
KDMC also alleges the Cabinet "has continued to look the other way" regarding Coventry's practices and "consistently refused to enforce its own rules or contracts or honor the assurances it made to the federal government" when
Because Coventry is now treating KDMC as an out-of-network provider, the hospital alleges it, like ARH, is being harmed by a "collusive agreement" between Coventry and the Cabinet that purports to allow Coventry to pay for out-of-network services at a rate that covers only a fraction of KDMC's costs.
In a news release, KDMC said Coventry's process of paying the hospital's claims has resulted in "consistent underpayment of millions of dollars for services rendered." The hospital also said it had attempted to resolve the issues with Coventry without litigation, "but no resolution is in sight."
Additionally, KDMC said it believed Coventry was canceling provider contacts in eastern
"We are concerned, however, that Coventry's actions in canceling provider contracts here will leave much of the
In an order entered in the lawsuit
Coventry told its members in September that it canceled its contract with KDMC, causing many to switch to different MCOs during the open enrollment that ended
Forrester also found that without the ARH hospitals, there was an "enormous geographic hole" in Coventry's network. According to KDMC, the hole has now doubled in size with Coventry's cancellation of its contract with the hospital. Twenty-four of the 33 counties that comprise Regions 7 and 8 in the
Coventry was one of three successful bidders to become authorized MCOs for
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