Sunday, Dec. 10, 2023 |
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KAILUA-KONA — Six weeks after Kaiser Permanente filed suit against The Queen’s Health Systems after the latter informed the former it would begin billing Kaiser members for the balance of emergency services it provides, Queen’s has yet to file a response in court.
The lawsuit, filed in mid-June, asks a federal judge to bar Queen’s from billing Kaiser members directly for emergency services they receive at Queen’s hospitals (with the exception of co-pays and deductibles) and declare Kaiser only has to pay “the reasonable value” for services provided to commercial members.
A spokesperson for The Queen’s Health Systems this week declined to offer additional comment beyond a statement released in the wake of the lawsuit’s filing.
“While we do not comment on pending litigation, we can say that we will continue to ensure all patients who seek our help, regardless of insurance coverage, receive the highest quality of care,” Queen’s said last month. “It has been our mission for 160 years to provide great clinical care for all the people of Hawaii, and we will continue to serve all patients, including Kaiser members, any time they need our services.”
The dispute stems from the expiration of a hospital services agreement between The Queen’s Medical Center and Kaiser Permanente at the end of May.
As a result, The Queen’s Health Systems hospitals, including North Hawaii Community Hospital, are no longer considered participating providers within Kaiser’s network.
Starting May 31, Queen’s said last month, services provided to Kaiser members — including Medicare Advantage members, Medicaid members, QUEST Integration members and commercial members — would be billed at non-participating provider rates.
A Kaiser spokesperson said in June that its members would still have access to and be covered for emergency and trauma services at all Queen’s hospitals.
On June 3, The Queen’s Health Systems executive vice president and chief financial officer Mich Riccioni said in a letter to Kaiser that emergency and non-emergency services would be provided to Kaiser commercial members at 100% of billed charges, and that Queen’s wouldn’t seek pre-authorization from Kaiser for those services. That letter was attached to the complaint Kaiser filed last month.
Medicare members and Medicaid members would be billed for emergency services at the respective rates for those plans.
The letter also said members would be billed for any services Kaiser doesn’t reimburse.
Kaiser filed its complaint on June 12, in which it argued that although the contract with The Queen’s Health Systems ended on May 30, the two “have an implied contract with respect to the provision and payment of emergency medical services,” and those implied contracts are regulated the same as any contract.
An answer to the complaint hasn’t been filed, but a scheduling conference has been scheduled for Aug. 12.
Summonses for The Queen’s Medical Center, Molokai General Hospital and North Hawaii Community Hospital were all recorded as served in the second half of June.
A Kaiser spokesperson said Kaiser members still have access to emergency services at Queen’s hospitals.
The spokesperson added that while they are awaiting a response from Queen’s to the lawsuit, “we continue to work with (Queen’s Health Systems) on a path to meet the health care needs of our members.”
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