Three of the state's largest health systems are carrying their battle over hospital beds into overtime.

Earlier this month, regulators approved Rex Healthcare's plan to build a 50-bed hospital in Holly Springs and add a new tower on its main Raleigh campus for a heart and stroke facility. They also said WakeMed could add 51 beds — 22 at its Cary campus and 29 at its main campus on New Bern Avenue in Raleigh.

But regulators with the Department of Health and Human Services denied Rex's request to build a 40-bed hospital in Wakefield and WakeMed's application to add 79 beds on its main Raleigh campus.  And Winston-Salem-based Novant, which has been trying to enter the lucrative Triangle health care market, was shut out completely. It had hoped to put a 50-bed hospital in Holly Springs.

Now all three are appealing the ruling, a move that sets up a long legal fight that could postpone a final decision for several years.