Judge asks Coventry, ARH to submit proposals to court by Thursday

vhoneycutt@herald-leader.comJune 12, 2012 

The dispute between managed-care company Coventry Cares and Appalachian Regional Healthcare continued Tuesday with a court hearing on whether Coventry has an adequate network without ARH to meet the medical needs of 25,000 Eastern Kentucky Medicaid patients.

ARH operates eight hospitals and other health clinics in the region.

After Coventry said it would sever its contract with ARH, the hospital company filed a lawsuit in U.S. District Court in Lexington. Coventry agreed to continue its contract until June 30 while renegotiating for long-term coverage.

ARH is asking for all Coventry members to have the opportunity to transfer to WellCare, the only other managed care company with which ARH has a contract.

Testimony at Tuesday's hearing centered on the method by which Coventry determined that its members would have an adequate network at hospitals and other health care providers within 60 minutes' driving time of their homes without ARH.

"What they showed was that they basically have a system where they feed in the numbers they want to get out the numbers that they want. It's a very result-driven methodology that they are using to show that they have adequacy but they really don't," Steve Price, an attorney for ARH, said after the hearing.

But Stephen Amato, an attorney for Coventry, said after the hearing, "We established that the network was adequate under the reasonable standards accepted in the industry."

"By no means should anyone conclude that Coventry is not committed to giving the members ... full access to health care. We'll do that no matter what the judge decides about this issue about adequacy," Amato said.

U.S. Senior Judge Karl S. Forester did not make a ruling, but he asked both sides to submit proposed findings to the court by Thursday.

Coventry is one of four companies hired by the state Cabinet for Health and Family Services to manage Medicaid in Kentucky since Nov. 1.

Christina Heavrin, an attorney for the Cabinet for Health and Family Services, said Tuesday that Coventry's network was adequate without ARH.

Price, the attorney for ARH, has said that the two sides could not come to a contract agreement because Coventry was asking ARH for a cut in Medicaid reimbursements that ARH found unacceptable. Medicaid's rates pay 75 percent of the cost of treating patients on an in-patient basis, and Coventry has asked for a further reduction, he said.

Valarie Honeycutt Spears at (859) 231-3409. Twitter: @vhspears

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