MONTGOMERY, Ala. (WSFA) – After a seven-hour hearing, Judge Christopher Hawkins says he will rule to either grant or deny Jackson Hospital’s emergency motion for a preliminary injunction against Blue Cross Blue Shield of Alabama.
Jackson Hospital and Blue Cross Blue Shield of Alabama have been in talks for months as the hospital tries to get the insurer to pay reimbursement rates similar to what Baptist Medical Center South gets paid.
Hospital leadership says if a deal isn’t reached to increase rates by June 25, Jackson Hospital will close at the beginning of July. Leadership testified that they picked that date because they project that week is when they will have just enough money to operate their closing plan, also testifying that the hospital would be out of money entirely by mid-August.
One of the biggest points of contention between the two is whether BCBS is negotiating rates in good faith or not.
Jackson’s counsel frames the current agreed-upon reimbursement rates as a move that was forced upon the hospital rather than being negotiated, as it had no leverage while going through bankruptcy.
The counsel for BCBS points to the past two years of what they believe are legitimate negotiations, pointing out that in both years not only were reimbursement rates increased, but they were increased mid-year for a second time when Jackson asked for financial help. The most recent cited negotiation was from December 2025, when Jackson’s rates went up 12%, according to BCBS counsel.
An independent study commissioned by Jackson Hospital with data from January to March of 2026 submitted in court showed that Baptist Medical Center South saw a 71% higher inpatient reimbursement rate, and a 40% higher outpatient reimbursement rate.
BCBS counsel had issue with the math on Jackson’s financial projections (if they were to keep existing reimbursement rates), believing they overstated payroll and that mistake when accounted for shows that Jackson would be operating at a profit.
While BCBS counsel says that it is true Baptist Medical Center South gets reimbursed 300% more for a normal childbirth than Jackson does, they explained that it’s because the two hospitals operate on a different per diem pay structure.
They showed that Jackson chose to operate on a tiered structure — meaning they are compensated more for severe cases and less for typical procedures – and Baptist South has a flat rate for all procedures, meaning they could be paid less than Jackson for severe cases.
BCBS representatives also claim that increased reimbursement rates for Jackson would raise insurance premiums for millions of their customers, and they have an obligation to weigh that factor in addition to healthcare access when setting rates.
Jackson’s counsel regularly mentioned that this matter was a “life or death” hearing, and that while they recognize they are requesting extraordinary relief, this is an extraordinary situation.
Jackson Hospital CEO John Quinlivan testified that he believes it doesn’t make financial sense for BCBS to set lower rates for Jackson Hospital, because if Jackson closes many of those patients would go to Baptist South where BCBS would have to pay the higher rate anyways.
After hearing both sides, Judge Hawkins narrowed in on a previous hearing in April where he believes Jackson’s counsel did not accurately portray the urgency in getting a matching reimbursement rate. Jackson’s counsel said it wasn’t their strategy to put the blame on BCBS at the last second, and there was another meeting at the governor’s office that day in April where reimbursement rates were discussed.
Judge Hawkins says he expects to file a brief ruling before the end of the business day on Wednesday.
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