HCA Health Servs. of Tenn., Inc. v. Bluecross Blueshield of Tenn., Inc. — June 2016 (Summary)

EMTALA

HCA Health Servs. of Tenn., Inc. v. Bluecross Blueshield of Tenn., Inc.
No. M2014-01869-COA-R9-CV (Tenn. Ct. App. June 9, 2016)

The Employee Retirement Income Security Act (“ERISA”) pre-empts most claims against a health insurer.  The plaintiffs in this case were eight hospitals owned by HCA.  The defendant was Blue Cross Blue Shield of Tennessee (“BCBST”).  The issue in this case involved HCA’s ability to sue BCBST to recover the cost of providing emergency care to BCBST enrollees of a plan in which HCA did not participate.

The Tennessee Court of Appeals affirmed a lower court’s grant of summary judgment against HCA which claimed that EMTALA and state law created an implied-in-law contract between itself and BCBST.  HCA argued that BCBST took advantage of HCA’s obligation under EMTALA to provide emergency care to its patients by paying HCA a cut-rate amount for services.

The court reasoned that the obligations imposed on HCA by EMTALA and the prohibitions imposed on the BCBST by state law to provide coverage for emergency services did not create an implied-in-law contract because HCA’s patients received the benefit of the emergency care and are, ultimately, the parties obligated to pay for services. BCBST satisfied its obligation by paying for the services that were agreed to with the patients. Therefore, the court concluded that without BCBST receiving a benefit from HCA, no implied-in-law contract was formed and, as a result, the court affirmed the lower court’s grant of summary judgment in favor of BCBST.