ACA Medical Loss Ratio Includes Insurer’s Settlement Payments, Judge Says

(May 3, 2017, 10:47 AM EDT) -- LOS ANGELES — More than $34 million an insurer paid as a result of improperly categorizing out-of-network providers counts as incurred claims for purposes of the Patient Protection and Affordable Care Act (ACA)’s medical loss ratio (MLR), a federal judge in California held May 1 in denying remand and dismissing a California unfair competition law action (Rebecca Morris, et al. v. Blue Shield of California, et al., No. 16-5914, C.D. Calif., 2017 U.S. Dist. LEXIS 66043)....