HMOs Needn't Pay When 3rd-Party Cos. Fail, Aetna Tells Court

Law360, Dallas (December 5, 2012, 3:56 PM EST) -- Aetna Inc. told the Texas Supreme Court on Wednesday that health maintenance organizations are not required under Texas law to pay hospitals for insurance claims if a third-party company that was processing the claims becomes insolvent.

The HMO is fighting to avoid responsibility for paying about 6,000 insurance claims filed by the Texas hospital system Christus Health Gulf Coast more than 12 years ago, when the third-party company that had been administering Aetna’s payments, North American Medical Management of Texas, went bankrupt. Christus contends the insurer...
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