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  • Writer's pictureZumpano Patricios

Significant Appellate Victory for ZP&W

Updated: Aug 21, 2018

AMEDNEWS contained an article on ZP&W's appellate victory in the Adventist Health System/ Sunbelt Inc. v. Blue Cross and Blue Shield case. The article cited the appellate decision as "the first round in what doctors and hospitals hope to be a larger victory." The article outlines Florida's 5th District Court of Appeal decision that "physicians and hospitals can take their payment disputes to court under a state law that requires HMOs to pay non-contracted health care professionals for emergency treatment they give patients who belong to the network." The article quoted John M. Knight, Esq., General Counsel to the Florida Medical Association, as stating that "this decision finally resolved the biggest question as to whether or not doctors have the right to sue, and it provides a redress for physicians who, in the past, had to basically accept whatever the HMO wanted to pay." Leon Patricios was quoted in the article as stating that Adventist Health System, which operates seven facilities in the Orlando area that are not part of the BCBS network, was not appropriately reimbursed because the BCBS payments "did not reflect the usual and customary charges for comparable services in the geographical area. Usual and customary provider charges means the charges that other health care providers usually and customarily bill for their services." Mr. Patricios further stated that this case should "give providers the certainty to know what they are going to get paid when they treat patients in an emergency situation."

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