WebTPA Disputes Its Role In Arbitration of Health Insurance Claim

On Friday, a case was filed in the Western District of Texas, Austin Division regarding the procedural actions that have been taken regarding a disputed medical billing. WebTPA alleged that it should not have been pulled in to the arbitration since it was not a party in the agreement at issue.

The case was filed by WebTPA Employer Service, L.L.C. against Post Acute Medical, LLC which does business as Warm Springs Specialty Hospital of Luling, and American Health Law Association. The plaintiff, WebTPA, is a third party administrator for medical insurance plans. In this role, WebTPA receives claims, processes them for benefits determinations, and prices the claims per contracts that WebTPA is a party to. 

In this role, WebTPA enters provider networks to supply additional providers for the medical plans and to obtain access to the pricing agreements that are available through those provider networks. One of these provider networks is Provider Healthcare System, which has a Preferred Facility Agreement (PFA) with Post Acute through its business as a specialty hospital. This PFA included an arbitration clause, however WebTPA claimed that it is not a party to this agreement.

According to the complaint, an insurance claim was processed by WebTPA and denied due to a pre-existing benefit clause. Eight years after the denial, the hospital in Luling initiated an arbitration action under the PFA and purported to include WebTPA as a party to this action. WebTPA disputed that proper service was made and also disputed that it is subject to the mandatory arbitration. 

American Health Law Association, the other defendant, moved forward with a status hearing on the arbitration despite WebTPA’s dispute of service and whether it is subject to the mandatory arbitration clause. WebTPA is moving for declaratory judgment regarding both of these issues and an injunction on the arbitration moving forward during the pendency of this case. 

WebTPA is represented by the firm of Figari & Davenport.