Aetna to pay $86M in arbitration settlement to HCA Healthcare

One of the nation’s largest health insurers, Aetna, will pay $86 million to HCA Healthcare after a lawsuit stemming from 2015 led to an arbitration trial.

The case related to Aetna’s out-of-network benefit payment and administration practices in Florida for service and care provided to members in Aetna’s individual Public Exchange products from 2014 to 2016. According to Aetna, which is now owned by CVS Health, coverage under Aetna’s individual Public Exchange products in the sunshine state was not available until after Dec. 31, 2016, according to a public filing from CVS Health.

According to HCA, Aetna paid too little for services rendered to HCA hospitals that provided emergency room care to out-of-network patients with insurance purchased on the public exchange under the Affordable Care Act. HCA Healthcare is a Tennessee-based hospital and healthcare facilities operator and is a Fortune 500 company.

Last year, HCA Healthcare was awarded $150 million by the trial arbitrator. Aetna’s appeal brought that down to $86 million on March 28, 2019. CVS Health, which completed its $69 billion merger with Aetna at the end of 2018, indicated the settlement amount in its first quarter earnings report.

The lawsuit was not the only trouble for Aetna lately. The health insurer also recently settled out of court with a patient who sued over coverage denial in California and is facing another lawsuit from a Florida hospital over other claims of coverage denial.