As you know, this law firm represents Gulf Coast Division, Inc. and its constituent hospitals (collectively, the “Hospitals”). Reference is made to the Hospital Services Agreement (effective February 1, 2004 and all amendments thereto (collectively, the “HSA”).
On June 2, 2005, we sent a demand letter to Aetna Health, Inc. in regard to its failure to have reimbursed the Hospitals in accordance with the HSA for items billed by the Hospitals as “Other Implants,” as defined by Revenue Code 0278. On January 15, 2016, we provided you with a copy of the Hospital’s Arbitration Demand that would be filed if no pre-arbitration resolution could be reached (see attached copy). The facts of this matter and the claim being asserted by the Hospitals …show more content…
Attached is a claims spreadsheet showing the particulars of each claim at issue and the amount owed. A password to the spreadsheet will be provided in a separate email.
The Hospitals continue to believe it to be in all parties’ best interest to discuss a resolution of the claims before arbitration proceedings are instituted. Accordingly, the Hospitals offer to settle this dispute in a manner similar to the terms of the implant settlement that Aetna entered into with HCA’s North Texas Division last year. A copy of the North Texas Division settlement agreement is attached for your reference. The proposed settlement agreement would include the following terms.
First, to compensate the Hospitals for the past implant underpayments, Aetna will agree to increase all fixed and percentage commercial rates by 0.8% until the $2,609,355.93 underpayment amount is recovered by the Hospitals (the “Temporary Rate Increase”). The Temporary Rate Increase will be governed by the same terms as are contained in Paragraph 4 of the North Texas Division settlement agreement, including terms governing the rate increase amount, rounding, Aetna’s provision of temporary rate increase sheets, the duration and expiration of the rate increase, an expedited dispute resolution process, overpayment/underpayment resolution, the removal of the rate increase, and Aetna’s provision of temporary rate increase expiration …show more content…
This same agreement was effectuated in the North Texas Division settlement by means of an amendment to the Terms and Conditions section of the Services and Compensation Schedule for North Texas. The Hospitals propose a similar amendment to the Hospitals’ HSA. Attached for your review is a proposed amendment for the Hospitals that is based on the North Texas Amendment.
Finally, the settlement agreement would include the same type of liability releases, confidentiality, and other settlement terms as are set forth in paragraphs 5 through 27 of the North Texas settlement agreement. Although the North Texas Division settlement agreement also required Aetna to permanently increase commercial rates by an additional 0.1% (the “Primary Rate Increase”), no such increase is being demanded by the Hospitals at this
On June 2, 2005, we sent a demand letter to Aetna Health, Inc. in regard to its failure to have reimbursed the Hospitals in accordance with the HSA for items billed by the Hospitals as “Other Implants,” as defined by Revenue Code 0278. On January 15, 2016, we provided you with a copy of the Hospital’s Arbitration Demand that would be filed if no pre-arbitration resolution could be reached (see attached copy). The facts of this matter and the claim being asserted by the Hospitals …show more content…
Attached is a claims spreadsheet showing the particulars of each claim at issue and the amount owed. A password to the spreadsheet will be provided in a separate email.
The Hospitals continue to believe it to be in all parties’ best interest to discuss a resolution of the claims before arbitration proceedings are instituted. Accordingly, the Hospitals offer to settle this dispute in a manner similar to the terms of the implant settlement that Aetna entered into with HCA’s North Texas Division last year. A copy of the North Texas Division settlement agreement is attached for your reference. The proposed settlement agreement would include the following terms.
First, to compensate the Hospitals for the past implant underpayments, Aetna will agree to increase all fixed and percentage commercial rates by 0.8% until the $2,609,355.93 underpayment amount is recovered by the Hospitals (the “Temporary Rate Increase”). The Temporary Rate Increase will be governed by the same terms as are contained in Paragraph 4 of the North Texas Division settlement agreement, including terms governing the rate increase amount, rounding, Aetna’s provision of temporary rate increase sheets, the duration and expiration of the rate increase, an expedited dispute resolution process, overpayment/underpayment resolution, the removal of the rate increase, and Aetna’s provision of temporary rate increase expiration …show more content…
This same agreement was effectuated in the North Texas Division settlement by means of an amendment to the Terms and Conditions section of the Services and Compensation Schedule for North Texas. The Hospitals propose a similar amendment to the Hospitals’ HSA. Attached for your review is a proposed amendment for the Hospitals that is based on the North Texas Amendment.
Finally, the settlement agreement would include the same type of liability releases, confidentiality, and other settlement terms as are set forth in paragraphs 5 through 27 of the North Texas settlement agreement. Although the North Texas Division settlement agreement also required Aetna to permanently increase commercial rates by an additional 0.1% (the “Primary Rate Increase”), no such increase is being demanded by the Hospitals at this