LITTLE ROCK — A hearing officer said Wednesday that he’ll reconsider requests to gather and present evidence that were denied for a 2008 hearing at the state Insurance Department in which Arkansas Surgical Hospital argued that major insurers were violating the state “any willing provider” law by paying them less than other hospitals are paid.
North Little Rock-based Arkansas Surgical Hospital will seek permission to obtain evidence, including different rates paid to some hospitals for providing the same medical services, as well as insurers’ justifications for disparities in those rates, said James Bowen, one of the hospital’s attorneys.
That information was denied by former Insurance Commissioner Julie Benafield Bowman, who presided over the 2008 hearing.
“We were trying the case basically like a blind man,” said Charles A. Gall, a Dallas attorney representing Arkansas Surgical Hospital, at a hearing Wednesday.
John Lineberger, a retired circuit court judge, is presiding as hearing officer in the case after Pulaski County Circuit Judge Jay Moody remanded the case to the department earlier this year. Moody wrote that there was “an appearance of impropriety” in the proceedings presided over by Bowman.
Bowman took a job with United Healthcare a few months after she ruled in favor of the insurer.
Bowen said Wednesday that “no matter how this comes out, it’s apparent that we’re going to get a fair hearing of the issues.”
Lineberger will make a recommendation to Insurance Commissioner Jay Bradford about whether United Healthcare, Arkansas Blue Cross and Blue Shield and QualChoice violated the state law when they paid Arkansas Surgical Hospital and two other specialty hospitals less than larger competitors such as St. Vincent Health System for the same services.
Arkansas Surgical has argued that the law requires hospitals to be paid through a method applied equally to all hospitals.
The insurers have said that they pay different rates for a variety of reasons. For example, United Healthcare officials testified in the 2008 hearing that they consider the size of a hospital and scope of services.
The law offered patients more choice in doctors and hospitals. It opened insurance networks to all providers that meet entry requirements.
On Wednesday, Lineberger said the attorneys will have 30 days to highlight passages in transcripts to show where they previously were denied requests to present evidence, and to explain why the request should be granted.
Attorneys for the other side will then have 30 days to reply.
Lineberger said if he finds a party was wrongfully denied evidence, that part of the record will be reopened.
“I’m trying to step back in time and step into [Bowman’s] shoes” to ensure everyone gets “a fair shake,” he said.
Otherwise, he said, the record on the case is complete.
John Tisdale, an attorney for QualChoice, had argued that no new evidence should be presented. Rather, he wanted the case to be dismissed or for Lineberger to judge it from the existing evidence.
Business, Pages 25 on 06/24/2010