Kaiser Permanente filed a temporary restraining order Thursday to block the Queen’s Health Systems from directly billing its members while a federal court determines whether or not the hospital is unfairly charging patients.
Kaiser filed a complaint in June in U.S. District Court to stop Queen’s from directly billing its members, with the exception of deductibles and co-payments, and to allow the HMO to pay only the “reasonable value of Queen’s emergency services,” which is “not necessarily 100%” of billed charges. Queen’s provides emergency services for hundreds of Kaiser members each year at a cost of several millions of dollars, according to the complaint.
The state’s largest health maintenance organization — both a medical provider and health insurer covering more than 250,000 members in Hawaii — said Queen’s is demanding it pay above market rates that exceed what other hospitals are charging.
“We remain committed to working toward a fair and equitable agreement with (Queen’s) but will not stand by while they threaten patients with surprise bills to gain bargaining leverage,” said Kaiser spokeswoman Laura Lott. “Unfortunately, (Queen’s) continues to threaten to bill patients for the balance of any charges, above what Kaiser Permanente pays. This practice, known as balance billing, is intolerable and puts patients, who may already be dealing with serious and stressful health issues, in the middle of a contract dispute.”
The payment dispute arose after a hospital services agreement expired on May 30 and the parties were unable to come to terms on a new contract. Queen’s said negotiations failed because of “Kaiser’s refusal to accept its responsibility to pay for the actual costs of services” for members with complicated medical conditions.
“The recent legal filing by Kaiser is a reaction to Queen’s request that the court dismiss the frivolous lawsuit filed by Kaiser. In the filing, Kaiser claims it has the unilateral right to determine how much it has to pay Queen’s and that Queen’s has no recourse but to accept whatever Kaiser decides to pay,” said Mich Riccioni, the hospital’s chief financial officer, in a statement. “Kaiser has not yet indicated — to the court or to Queen’s — how much it plans to pay for Queen’s services. That is completely unacceptable and is the reason Kaiser’s members face the prospect of receiving bills from Queen’s.”
Queen’s previously said it will continue to send initial bills directly to Kaiser and that members will only receive invoices if the insurer refuses to pay. However, billing will be under the “industry standard process” for higher-cost out-of-network services provided to Kaiser members after May 30.