ETMC Sues Three Insurance Companies

TYLER – East Texas Medical Center Tyler has filed suit in excess of $1 million against three of the largest health insurance carriers in East Texas. According to a news release, the suit claims that the hospital’s exclusion from the preferred provider networks (PPO) of these companies has created serious and negative consumer impacts. The insurance companies named in the suit are Blue Cross & Blue Shield of Texas, a division of Health Care Service Corporation; Aetna Health, Inc., Aetna Life Insurance Company; Cigna Healthcare of Texas, Inc.; and Cigna Health and Life Insurance Company.

ETMC Tyler, one of the largest hospitals in the region, alleges that its exclusion lessens consumers’ choice of quality health care providers and increases healthcare costs for some patients. The suit also states that the exclusion of ETMC Tyler is contrary to the provisions of the Texas Insurance Code. Chapter 1301 of this code requires that insurance companies provide “a fair, reasonable, and equivalent opportunity to apply to be and to be designated as a preferred provider.” The code states further that carriers “may not unreasonably withhold a designation as a preferred provider.”

“ETMC’s involuntary exclusion is unique in the State of Texas in terms of its treatment by Blue Cross, Aetna and Cigna,” the suit states. “For example, there are 271 not-for-profit charitable hospitals in Texas. ETMC is the only general acute care community hospital involuntarily excluded from the Blue Cross PPO.”

“We are a charitable not-for-profit hospital seeking to fulfill our mission of providing for the health care needs of the residents of East Texas,” said Elmer G. Ellis, president and CEO of the East Texas Medical Center Regional Healthcare System. “Litigation was the last resort but sadly it is necessary if we are to fulfill this important mission.” Blue Cross had no immediate comment. Cigna said in an email that it does not comment on pending litigation. Aetna had no immediate comment either, with a spokesperson saying Tuesday afternoon that to her knowledge the company had not yet been served.