|Hazard Appalachian Regional Medical Center, one of|
eight ARH hospitals. Courier-Journal photo, copyright 2000
U.S. Senior Judge Karl Forester said the Cabinet's refused to "process requests by patients to transfer away from Coventry Cares, a managed-care organization, in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.
ARH and Coventry, part of Coventry Health and Life Insurance Co., battled it out in court earlier this year when Coventry wanted to terminate its contract in May — six months before its contract was set to expire — with the hospital chain, which covers 25,000 patients. In turn, ARH filed a lawsuit asking for a preliminary injunction to avoid the termination, which was ultimately granted. The injunction states Coventry must continue to pay ARH for services until Nov. 1. But the cabinet was supposed to help facilitate the transfer of patients from Coventry to Wellcare, the only other company that has a contract with ARH, in the meantime. Forester said in his order about 6,000 transfer requests "were being held by the Cabinet," Spears reports.
Mike Wynn of The Courier-Journal reports that 8,400 patients have sought to switch to Wellcare from Coventry since May.
Though Forester said he will decide whether to impose sanctions on the cabinet at a later date, but did not require "the cabinet to process transfer requests with the start of open enrollment only five weeks away," Wynn reports. The open enrollment window is between Aug. 20 and Oct. 19, Spears reports.
Cabinet attorney argued processing transfers was unnecessary since Coventry had been forced to pay for services through the open enrollment period. ARH argued stopping the requests creates confusion.
In response to the ruling, the cabinet praised Forester for acknowledging "the need to allow the Medicaid program to proceed with open enrollment so as not to cause a gap in service or confusion for members."
"Member support is extremely important and the cabinet remains committed to listening to concerns from Medicaid members about their managed-care company as well as medical providers," the statement continued.