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From The News-Courier staff—
knox city—Seeing no resolution from its complaint to the Texas Department of Insurance about getting $12 million in alleged unpaid claims from Aetna U.S. Healthcare, Knox County Hospital District representatives have formally urged legislators, including Rep. James Frank of Wichita Falls to step in.
“For the past 100 weeks Aetna U.S. Healthcare has failed to pay Clean Claims submitted by the Knox County Hospital District,” wrote Kelly C. Dawson, of The Dawson Group in Austin, representing the Knox County Hospital, in a letter to 23 Texas senators and representatives, including Rep. Frank.
The taxpayers of Knox County are owed more than $12 million, which this insurance company refuses to pay,” Dawson wrote.
“For those of you (who) have not yet taken the opportunity to contact TDI, I urge you to do so. While Knox County Hospital may not be in your district, if outright refusal to pay bills for services provided is allowed to go unpunished by the state of Texas, the next provider could well be one in your legislative district,” wrote Dawson.
“TDI has failed to enforce the Texas Insurance Code Prompt Pay statute that ensures Clean Claims are paid. Without mitigation, the Department of Insurance has left providers without an avenue of recourse of remedy.”
The letter continued that the request for intervention comes at a critical point, as the state and the nation combat the COVID-19 pandemic, and how financial strain limits rural hospitals, especially, from addressing health care needs at this difficult time, the le.
“Rural and community hospitals are the dividing line between our ability to overcome this crisis,” Dawson’s letter says. “While rural and community hospitals stand ready to serve this state they are absolutely limited by capabilities, In no uncertain terms, I wish to impress upon you that rural and community hospitals lack funding, equipment, and essential resources. Rural community hospitals are close to a breaking point. Our current health care crisis will surely exacerbate an already dire situation.”
Dawson’s letter doesn’t define the struggle as a miscommunication, but a matter of enforcing the Prompt Pay Statue of the Texas Insurance Code, which imposes deadlines on insurers addressing claims. “The only reasonable and timely recourse our hospitals have is the enforcement of the state’s Prompt Pay statute,” Dawson wrote. “The Texas Department of Insurance must enforce the law.”
Rep. Frank told the Times Record News he had been working with Knox County Hospital District on their issues of unpaid claims for nearly two years now, first with Blue Cross Blue Shield of Texas and now with Aetna.
“They first notified us about their payment issues with Aetna in March and my staff and I immediately began working with the Texas Department of Insurance to address their concerns, “ Frank said. “Since then, we have worked diligently to make sure that TDI has the information it needs from the district and have helped solve miscommunication issues between the two.
“Knox County Hospital is essential to the residents of Knox and surrounding counties. It is facing the same challenges that many of the state’s rural hospitals are facing and I will continue to do everything I can as their state representative to assist them in payment of claims and any other issues they encounter.”