Christus Health Gulf Coast v. Aetna, Inc. and Aetna Health, Inc.

The Texas Prompt Pay Statute entitles physicians and providers to swift payment of undisputed healthcare claims. This case asks whether the duty to pay promptly can be shifted from one company to another. Specifically, can several Houston-area hospitals seek prompt-pay penalties against a health maintenance organization (HMO) for nonpayment of medical services provided to patients under contracts the hospitals had with the HMO’s delegated network, rather than with the HMO itself? The plain language of the Prompt Pay Statute forecloses such a suit: Providers must have contractual privity with…