Hospitals affiliated with Nashville, Tenn.-based HCA Healthcare have sued multiple insurers over alleged claim denials and reimbursement issues in 2025 and 2026. These cases contribute to a broader landscape of legal battles between providers and insurers.
Most recently, seven hospitals filed a lawsuit Oct. 5 against Anthem Blue Cross and Blue Shield Georgia, part of Elevance Health. The complaint argued the insurer is on the hook for more than $501,213 in reimbursement, alleging underpaid or denied claims.
The lawsuit cites eight Anthem members, some with denied authorizations due to a purported lack of medical necessity. The complaint included cases involving emergency and post-stabilization care services, claiming Anthem would be responsible for payment under state and federal laws. According to the lawsuit, some claims and appeals were also denied as duplicates or for missing information.
The geographic reach of these hospitals is wide, spanning Utah, Tennessee, Missouri, North Carolina, Kansas and Texas.
HCA-affiliated hospitals in Texas filed a similar lawsuit against another out-of-state payer, Pennsylvania’s Independence Blue Cross, in September. The lawsuit targeting IBX alleged the insurer owed the Texas hospitals at least $345,319.
Not only is HCA Houston Healthcare North Cypress listed as a plaintiff in both the Anthem and IBX actions, but the plaintiffs are also working with the same law firm.
The legal actions against Anthem and IBX center on the insurers’ obligations as Blues plans. The BlueCard Program allows members of one Blue Cross Blue Shield Association licensee plan to access covered care in another licensee’s service area. Both lawsuits point to the insurers listing online that the hospitals are in network. The lawsuits also bring a breach-of-contract count as the primary claim, while surfacing alternative legal arguments. These lawsuits remain ongoing.
A previous lawsuit focused on a separate issue. In February 2025, 17 HCA-affiliated hospitals in Florida filed a lawsuit against UnitedHealthcare in the state’s 9th Judicial Circuit Court. The complaint alleged the insurer paid for emergency care provided to ACA members at rates that were too low, claiming the insurer underpaid by more than $145 million since 2022.
The plaintiffs argued that, despite being out of network, they provided emergency services to more than 5,000 UnitedHealthcare members. Citing state law, the hospitals alleged UnitedHealthcare needed to pay the lesser of provider’s charges, the usual or customary charges for similar services in the community, or a mutually agreed upon charge.
But, just months after the initial complaint, both the hospitals and UnitedHealthcare agreed to dismiss the case without prejudice, closing the case without designating which parties won based on merits. The hospitals could refile the same claims at another point in time.
While the more recent cases involve smaller amounts and hinge on how Blues plans operate out of state, the three lawsuits show how HCA hospitals across the country are turning to the courts to recover reimbursement from insurers.
HCA hospitals are not the only ones escalating disputes with insurers. Philadelphia-based Jefferson Health also filed a lawsuit against IBX this year over nearly $100 million in disputed payments, as well as another lawsuit targeting Aetna’s Medicare Advantage inpatient reimbursement policy. The California Hospital Association brought a lawsuit against Anthem Blue Cross, focusing on a policy that would penalize hospitals when patients get care from out-of-network physicians, despite the hospital’s in-network status.
Becker’s has reached out to HCA for comment and will update this story if more information becomes available.
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