Florida hospital sues Aetna over readmission payment policy

Lakeland (Fla.) Regional Health filed a lawsuit against Aetna claiming the insurer arbitrarily denied payment for readmitted patients, according to The Ledger.

The lawsuit, filed in January, argues that Aetna refused to reimburse the hospital properly under its readmission payment policy. The policy determines how much Aetna pays Lakeland for services provided to an individual during his or her second hospital visit for a medical issue within 30 days of discharge.

"Many of the readmissions which have been denied by Aetna are patients who are chronically ill with many comorbidities," Lakeland's complaint states, according to The Ledger. "As such, the cases are complex and cannot be cavalierly denied as Aetna has done under the guise of its policy."

Lakeland is suing for more than $1 million from Aetna, claiming the policy has caused financial damage and is a breach of contract. However, Aetna moved to dismiss the lawsuit April 26, arguing that its policy intends to improve healthcare quality for its members.

"The readmissions policy is designed to prevent a facility, like Lakeland, from failing to provide appropriate and complete care as part of an initial hospital admission," according to Aetna's response, cited by The Ledger. "If the conditions had been properly treated as part of the initial admission, the second admission would not be necessary."

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