This was a landmark case over the proper rate that health insurance companies should pay out-of-network emergency room doctors under the Affordable Care Act. HKH represented the plaintiffs, ACS Primary Care Physicians Southwest and Emergency Services of Texas, and argued that the insurance company, in this case Molina Healthcare, failed to properly pay a customary rate for emergency care performed. Many experts believed this case was set to be the legislative template to be viewed in other states and jurisdictions across the country that are facing the same issue.
This case was challenging because it was the first case of its kind and everyone has strong opinions about health care, both good and bad.
Through deep dives into the claims data, HKH was able to clearly demonstrate that Molina rarely entered into contracts with emergency room physicians – preferring instead to force physicians to take what Molina decides to pay after the treatment is rendered.
HKH worked to show the jury that a verdict in their favor would make it more likely that the emergency health care system wouldn’t crater.
The case resulted in the jury awarding the plaintiffs $19M in damages.