About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

86 Tul. L. Rev. 1385 (2011-2012)

handle is hein.journals/tulr86 and id is 1397 raw text is: The Louisiana Supreme Court Endorses Health Care Providers' Freedom To Contract for Below-Schedule Reimbursement Rates in Agilus Health v Accor Lodging North Ameica I. OVERVIEW .......................................... 1385 II. BACKGROUND ........................... ....... 1387 III. THE COURT'S DECISION ................................. 1390 IV ANALYSIS .......................................... 1393 I. OVERVIEW The Louisiana Supreme Court has confirmed the validity of discount provisions in preferred provider organization (PPO) agreements under the Louisiana Workers' Compensation Act (LWCA), thereby resolving a conflict that had developed between Louisiana state and federal courts.' The litigation in the noted case arose out of a reimbursement dispute between members of the First Health PPO network: health care provider Agilus Health and payor Liberty Mutual Insurance Company (Liberty Mutual).2 Under its PPO agreement with First Health, Agilus Health agreed to be reimbursed by the network's payors for certain services at discounted rates; the agreement included the provision: If any state law or regulation establishes rules or guidelines for the payment of health care services, reimbursement shall not exceed 85% of the maximum amount payable under such rules or guidelines.3 First Health later reduced the reimbursement rate to 80% of the maximum amount by a letter sent to Agilus Health amending the contract.4 Insurer Liberty Mutual joined the First Health PPO network as a payor subject to a similar provision setting reimbursement rates for workers' compensation services at 80% of the reimbursement schedule under the LWCA.' Liberty Mutual provided workers' compensation insurance for Accor Lodging North America (Accor).' Agilus Health 1. Agilus Health v. Accor Lodging N. Am., 2010-0800, pp. 6, 10-12 (La. 11/30/10); 52 So. 3d 68, 72, 75-76. 2. See id at pp. 1-3; 52 So. 3d at 70-71. 3. Id. at p. 2; 52 So. 3d at 70. 4. Id at p. 2 n.1; 52 So. 3d at 70 n.1. 5. Id at p. 3; 52 So. 3d at 71. 6. Id at p. 2; 52 So. 3d at 71. 1385

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most