ProMedica can exclude McLaren St. Luke’s from its provider network, court rules


ProMedica won a court fight over excluding an Ohio hospital from its insurance subsidiary’s provider network Tuesday.

The federal court ruling means its insurer Paramount does not have to accept McLaren St. Luke’s Hospital in Maumee, Ohio, into its network. The U.S. 6th Circuit Court of Appeals in Cincinnati vacated a preliminary injunction that forced Paramount to keep St. Luke’s in its health plans in December.

Paramount removed McLarenSt. Luke’s from its network after the hospital merged with Grand Blanc, Michigan-based McLaren Health Care. McLaren St. Luke’s subsequently filed an antitrust case against Paramount and ProMedica.

In the ruling issued Tuesday, the appeals court vacated the prior injunction because Toledo, Ohio-based ProMedica “had a legitimate business explanation for ending the relationship” and that “St. Luke’s is unlikely to show that ProMedica unlawfully refused to continue doing business with it,” the ruling says.

“We are very pleased with the 6th Circuit’s decision,” Mark Wagoner, one of ProMedica’s attorneys, said in a news release. “Paramount has always been focused on the best interests of its plan members, and we appreciate that the court of Aapeals expressly recognized the competitive benefits that a lower cost, narrow network health plan, like Paramount, provides to members and employers.”

McLaren St. Luke’s is “deeply deeply disappointed to learn that the injunction was reversed,” the hospital said in a news release. “McLaren St. Luke’s strongly believes our community deserves a choice in where they receive care, and we are saddened that ProMedica’s actions continue to disrupt the important relationships thousands of patients have built with their physicians and caregivers. We will continue to explore legal options,” the hospital said.


Source: modernhealthcare.com

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