Appellate court hears dispute over when managed‑care pays for post‑stabilization ER care

Summary

In oral argument, counsel for AmeriChoice and Erlanger disputed whether federal regulations or contract terms required a treating‑physician 'notice of stabilization' before AmeriChoice became financially responsible for post‑stabilization hospital care; the court probed factual gaps in the record and the parties' competing damage calculations.

William Jordan, counsel for AmeriChoice, told the court he was urging reversal of the Court of Appeals and affirmation of the Chancery Court on when managed‑care plans must reimburse out‑of‑network hospitals for patients who arrive by emergency transport. Jordan said the regulatory scheme (including EMTALA and provisions cited as 42 C.F.R. provisions governing transfers) makes payment obligations change only when a treating physician on‑site determines a patient is “stable for transfer.” He argued the record does not contain such treating‑physician determinations or a communication to AmeriChoice that would qualify as a request for post‑stabilization care authorization.

Jordan said Erlanger transmitted inpatient‑admission faxes and AmeriChoice replied with a reference number “not a guarantee of payment,” and that AmeriChoice’s corporate designee conceded no transmission of a contemporaneous post‑stabilization request occurred. “It did not,” Jordan said when asked whether AmeriChoice authorized Erlanger to provide post‑stabilization care. He added that AmeriChoice…

Appellate court hears dispute over when managed‑care pays for post‑stabilization ER care

Summary

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