United denied injunction, will pay in-network rates

Dec. 16--CORINTH -- Even though United Healthcare was denied an emergency injunction Thursday, the insurer said it will continue to pay in-network rates as North Mississippi Health Services moves to terminate its provider contracts because of a payment dispute.

"United Healthcare's top priority is its members' continued access to the care they need," said Kristen Hellmer of United Healthcare corporate communications on Thursday. "We feel strongly that NMHS should honor its existing contract while both our organizations continue their work with a third-party arbitrator to resolve this issue."

Attorneys for United Healthcare had asked First District Chancery Judge Michael Malski to grant an emergency injunction to keep the contract in force until arbiters could be appointed to resolve the dispute saying irreparable harm would be done to United Healthcare's customers and its reputation.

North Mississippi Health Services decided to terminate its contract with United Healthcare after months of work to resolve the payment dispute failed to gain traction. The Tupelo-based health care system discovered remittances from United that came through the electronic payment system marked as paid at $0. The unpaid bills amount to tens of millions of dollars, and NMHS accused United Healthcare of stonewalling attempts to correct the problem, according to testimony in chancery court Thursday.

United Healthcare states the claims were largely paid correctly and that NMHS has improperly terminated the contract.

North Mississippi Medical Center-Tupelo will officially exit United Healthcare's network at the end of the month. The contracts for the other community hospitals and clinics are not due to expire until later in 2017.

The injunction request was filed Dec. 9 in Lee County Chancery Court, but was heard in Corinth where Malski was presiding over other matters on Thursday. After hearing the arguments, Malski cited Mississippi Supreme Court precedents in other cases involving arbitration. He ruled against the United Healthcare request, saying it had failed to show two things.

First, the judge found United Healthcare did not show there would be irreparable damage. Malski said he felt any damage that occurs will be able to be measured in dollars. Second, United Healthcare failed to show that it would probably prevail in arbitration. Malski wasn't making a judgment on the merits of the case; he was indicating there were too many matters of fact in the case that will have to be investigated and decided before it will be clear which side will prevail.

Next steps

North Mississippi Health Services will have to decide if it will accept the in-network payments. The hospital reaffirmed its commitment to turn no United Healthcare patients away at Thursday's hearing.

"We will collect what is appropriate," said NMHS vice president and general counsel Bruce Toppin in response to United Healthcare attorneys during the Thursday morning hearing. "Your client can decide to pay at in-network rates."

Mississippi Insurance Commissioner Mike Chaney has asked the hospital system not to charge consumers beyond previously negotiated rates. He requested both parties send him plans by Monday to ensure that consumers and patients continue to receive medical care on an in-network basis pending a resolution of the subject dispute.

"This plan should include the continued payment of network charges without balance billing the consumer and should detail what has been done to date to ensure that consumers have not been adversely impacted by the dispute," Chaney's order stated.

The insurance department is continuing with a market conduct examination of United Healthcare, and the insurance department team has met with both parties and is gathering extensive data for review and analysis. Depending on the outcome, Insurance Commissioner Mike Chaney can order payments and levy fines.

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