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Mealey's Health Care / ACA

  • March 24, 2023

    Air Transport Company Says School District Isn’t Immune From Compensation Suit

    FRESNO, Calif. — A school district operating a self-insured health plan is not entitled to immunity as a public entity from claims that it undercompensated for emergency air transport, a company tells a California appeals court.

  • March 24, 2023

    Substance Abuse Providers See ERISA, UCL, Contract Claims Largely Fail

    SANTA ANA, Calif. — A dozen substance abuse providers’ reimbursement claims lack any evidence that relevant Employee Retirement Income Security Act plans require payment at the levels they suggest, and the California unfair competition law (UCL) claim lacks any tie to a statutory basis on which the claims could be brought, leaving only oral contract claims remaining, a federal judge in California said in granting a motion to dismiss.

  • March 23, 2023

    Labor Department Leads Amici In Seeking Rehearing Of Claim Reprocessing Ruling

    SAN FRANCISCO — Amici curiae filed five briefs in support of rehearing after a Ninth Circuit U.S. Court of Appeals panel found that a class cannot seek reprocessing of its health insurance claims, with the secretary of Labor saying the ruling conflicts with precedent from every circuit, and a bevy of providers warning about the potential fallout and wondering about the point of even having insurance if insurers can simply reject care decisions by medical professionals.

  • March 23, 2023

    Hospital Largely Escapes Damages In ACA Deafness Discrimination Case

    CENTRAL ISLIP, N.Y. — Evidence that a hospital at times provided an interpreter for a deaf woman and her allegations that the law requires one at every critical encounter raise more questions about her case than it answers, and under recent precedent, she can seek only nominal damages, a federal judge in New York said in denying her summary judgment and partially granting the provider’s motion.

  • March 22, 2023

    Assignee Says Bristol Provides Standing To Sue Insurers Under ERISA

    PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals should ignore insurers’ “novella about the history of standing” and instead follow the clear precedent giving an assignee the power to pursue them under the Employee Retirement Income Security Act, a debt collector tells the Ninth Circuit U.S. Court of Appeals in a reply brief.

  • March 21, 2023

    Insurer Downplays Need For Review Of Texas Arbitration Payment Dispute

    FORT WORTH, Texas — An insurer told the Texas Supreme Court on March 20 that it could reject a petition for review challenging an appellate court’s reinstatement of an out-of-network dispute arbitrator’s award, saying the case presents only a question of “routine judicial deference.”

  • March 20, 2023

    Government Says Flexible Drug Program Rule Doesn’t Run Afoul Of ACA Cost Sharing

    WASHINGTON, D.C. — Because a rule grants states and insurers flexibility in determining whether manufacturers’ drug assistance programs fall under the cost-sharing requirements of the Patient Protection and Affordable Care Act (ACA) and doesn’t determine substantive rights, a legal challenge to it fails, the government tells a federal judge in a cross-motion for summary judgment and opposition.

  • March 20, 2023

    Judge:  Hearing Loss Coverage Exclusion Doesn’t Constitute Proxy Discrimination

    SEATTLE — Two individuals have not shown that a blanket exclusion on hearing loss treatments targets those with a hearing disability or that the exclusion falls mostly on disabled individuals, a federal judge in Washington said in granting a motion to dismiss.

  • March 16, 2023

    Judge Seeks Briefing About Staying Section 1557 Discrimination Case

    TACOMA, Wash. — A federal judge in Washington pondering a motion to decertify a class alleging transgender discrimination under the Patient Protection and Affordable Care Act (ACA) issued an order to show cause asking for briefing on whether he should stay the case pending the outcome of a motion for rehearing in the wake of Wit v. United Behavioral Health.

  • March 16, 2023

    Panel Deems Arbitration Agreement Unenforceable In Pharmacies’ UCL Suit

    SAN FRANCISCO — A California appellate panel on March 15 held that an arbitration agreement between a pharmacy benefits manager (PBM) and 22 independent pharmacies was “unconscionable” and affirmed a trial court’s ruling allowing the pharmacies to sue the PBM for violating California’s unfair competition law (UCL) and other statutes for conduct allegedly including price-fixing and diverting their business to its own mail-order pharmacy.

  • March 16, 2023

    Blanket Wilderness Therapy Exclusion Doesn’t Violate Parity Act, Judge Says

    SALT LAKE CITY — A health insurance plan’s blanket exclusion on wilderness therapy does not violate the Parity Act, an outcome that is not avoided by a claimant’s arguments about licensing or how an independent reviewer reached a conclusion affirming the benefits decision, a federal judge in Utah said.

  • March 15, 2023

    Class Wants 9th Circuit To Take Another Look At ERISA Claim Reprocessing Ruling

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals deviated from a “unanimous chorus of authority” when it determined that claims reprocessing is a means to an end rather than a remedy itself in an Employee Retirement Income Security Act case, a ruling that will produce “nightmarish” results for courts, a class argues in a petition for rehearing.

  • March 15, 2023

    5th Circuit: Statutory, Regulatory Regimes Support Proton Beam Coverage Decision

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel sympathized with a woman’s challenge to the denial of coverage for proton beam therapy in the face of a “maddening” and “byzantine” health care system but said in affirming dismissal of her claims that its hands were tied by the statutory and regulatory realities.

  • March 15, 2023

    Class Motions On Takings Claim In ACA Reinsurance Row Stayed For Summary Judgment

    WASHINGTON, D.C. — Pending resolution of a motion for partial summary judgment, a U.S. Court of Federal Claims judge has stayed two motions related to class certification of a takings claim in a case concerning the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).

  • March 15, 2023

    COVID Test Provider’s Suit Alleging Underpayment By Insurer Dismissed By Judge

    SAN FRANCISCO — A California federal judge entered judgment dismissing a lawsuit for failure to file an amended complaint by a coronavirus testing site operator that had accused an insurer of failure to reimburse providers for COVID-19 tests allegedly in violation of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act and other statutes.

  • March 14, 2023

    D.C. Circuit Affirms Summary Judgment In Uncompensated Care Case

    WASHINGTON, D.C. — The way the Department of Health and Human Services (HHS) calculates uncompensated care provided by hospitals after passage of the Patient Protection and Affordable Care Act (ACA) is not subject to challenge and falls outside the type of procedural challenge that can be brought, the District of Columbia Circuit U.S. Court of Appeals said.

  • March 13, 2023

    Preliminary OK Sought For Amended Class Settlement In ERISA Surgery Coverage Row

    SAN FRANCISCO — An amended class settlement proposal addresses the concerns that resulted in its predecessor being denied preliminary approval, both parties in a class suit over a health plan’s denial of coverage for a specialized form of liposuction to treat lipedema told a California federal court.

  • March 09, 2023

    Judge Dismisses ACA, ERISA, CARES Act Compensation Claims

    BRIDGEPORT, Conn. — A federal judge in Connecticut dismissed claims alleging underpayment for testing and treatment for COVID-19 with leave to amend, finding that the Patient Protection and Affordable Care Act (ACA) and two other statutes governing payments for COVID-19 procedures lack a private right of action and that Employee Retirement Income Security Act claims are not specific enough.

  • March 09, 2023

    Judge: As Pleaded, COVID-Testing Lab’s Reimbursement Claims Preempted By ERISA

    NEWARK, N.J. — In a lawsuit brought by a medical testing laboratory seeking reimbursement for COVID-19 testing from a group of health insurers, a New Jersey federal court granted the insurers’ motion to dismiss with leave to amend five of the counts, ruling that there was either no private right of action for reimbursement or the claims were preempted by the Employment Retirement Income Security Act, and denied a motion to dismiss one of the defendants from the complaint.

  • March 07, 2023

    Head And Neck Cancer Class Seeks Approval Of Proton Beam Therapy Settlement

    PHILADELPHIA — A class of head and neck cancer sufferers has asked a federal judge in Pennsylvania for preliminary approval of a settlement resolving claims that denial of insurance coverage for proton beam therapy (PBT) violated Employee Retirement Income Security Act fiduciary duties.