HANNIBAL, Mo. — Two religious employers who had challenged the contraceptive mandate included under the Patient Protection and Affordable Care Act (ACA) were awarded nearly $400,000 in attorney fees and expenses on Aug. 9 by a Missouri federal magistrate judge following the federal government’s decision to drop its opposition to their motion for a permanent injunction (Sharpe Holdings, Inc., et al. v. United States Department of Health and Human Services, et al., No. 12-92, E.D. Mo., 2018 U.S. Dist. LEXIS 134297).
SEATTLE — A Washington federal judge on Aug. 9 narrowed the claims in a class complaint filed by a teenager seeking reimbursement for an outdoor mental health treatment program, dismissing with prejudice a claim that the denial of reimbursement was improper under the Employee Retirement Income Security Act and claims seeking to enforce the plan and for equitable remedies, to the extent that they relied on a violation of the Affordable Care Act (ACA) (A.Z., et al. v. Regence Blueshield, et al., No. 17-1292, W.D. Wash., 2018 U.S. Dist. LEXIS 134669).
BENTON, Ill. — A federal judge in Indiana on Aug. 1 said he would permit 62 additional plaintiffs into a class action alleging that an insurer denied applied behavioral analysis (ABA) autism treatments in violation of Indiana law and the Employee Retirement Income Security Act and noted that the defendant agreed to increase the settlement fund resolving the claims by $325,000 (W.P., et al. v. Anthem Insurance Companies Inc., No. 15-562, S.D. Ind.).
BALTIMORE — Having failed to pass legislation repealing the Patient Protection and Affordable Care Act (ACA), President Donald Trump now hopes to undermine it through neglect and sabotage, a collection of states and cities allege in an Aug. 2 complaint filed in Maryland federal court (Columbus, et al. v. Donald J. Trump, et al., No. 18-2364, D. Md.).
TRENTON, N.J. — An out-of-network provider is not a beneficiary of an Employee Retirement Income Security Act plan, and because the plan includes an anti-assignment provision, it cannot sue to recover benefits under the law, a federal judge in New Jersey held July 31 in remanding the action (Advanced Orthopedics and Sports Medicine Institute v. Blue Cross Blue Shield of New Jersey, et al., No. 17-11807, D. N.J.).
NASHVILLE, Tenn. — An insurer’s policy requiring that certain prescriptions be filled at specialty pharmacies appears to cover drugs disabled individuals would use and those used by others, dooming a man’s class action lawsuit alleging discrimination under the Patient Protection and Affordable Care Act (ACA), a federal judge in Tennessee said July 30 (John Doe, et al. v. Bluecross Blueshield of Tennessee Inc.., No. 17-2793, W.D. Tenn.; 2018 U.S. Dist. LEXIS 126845).
WASHINGTON, D.C. — An insolvent health insurer on July 30 asks that the Federal Circuit U.S. Court of Appeals grant rehearing en banc, vacate its decision and enter judgment against the United States for billions in Patient Protection and Affordable Care Act (ACA) risk-corridor funds (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 17-1224, Fed. Cir.).
WASHINGTON, D.C. — A U.S. Department of Labor final rule twists the Employee Retirement Income Security Act, permitting associations to offer non-Patient Protection and Affordable Care Act (ACA)-compliant health plans and “increases the risk of fraud and harm to consumers, requires states to redirect significant enforcement resources to curb those risks, and jeopardizes state efforts to protect their resident through stronger regulation. The rule is unlawful and should be vacated,” numerous states complain in a July 26 lawsuit filed in District of Columbia federal court (New York, et al. v. U.S. Department of Labor, et al., No. 18-1747, D. D.C.).
NEW YORK — A health insurer denied necessary behavioral health treatments for a severely autistic individual despite plan language imposing no limitations or exclusions on such services, the patient’s father claims in a July 25 complaint in New York federal court (Harry DeMeo, M.D., et al. v. Oxford Health Plans [NY] Inc., et al., No. 18-5208, E.D. N.Y.).
TRENTON, N.J. — It’s possible that a medical provider could prevail under contractual ERISA claims or on a count seeking other relief, and at this stage pleading both is permissible, a federal judge in New Jersey held July 20 (University Spine Center v. Aetna Inc., et al., No. 17-8747, D. N.J.).
NEW ORLEANS — The Patient Protection and Affordable Care Act (ACA) incorporates the definition of discrimination and prerequisites for filing suit from other statutes that do not require exhaustion of administrative remedies in cases involving federal grantees, a federal judge in Louisiana said July 17 (Joseph Lockwood v. Our Lady of the Lake Hospital Inc., No. 17-509, M.D. La.).
SAN FRANCISCO — A federal judge in California on July 18 dismissed a case challenging President Donald Trump’s revocation of Patient Protection and Affordable Care Act (ACA) cost-sharing measures after the plaintiffs informed him that the states managed to largely mitigate any damage from the move (California, et al. v. Donald J. Trump, et al., No. 17-5895, N.D. Calif., 2018 U.S. Dist. LEXIS 120200).
TRENTON, N.J. — It is impossible to tell from an illegible assignment of benefits just what powers an insured was granting his provider, and nothing in the complaint suggests that the assignment satisfied the requirements stated in the summary plan description, a federal judge in New Jersey held in dismissing an action on June 28 (University Spine Center, et al. v. United Healthcare, No. 17-8789, D. N.J., 2018 U.S. Dist. LEXIS 107828).
TRENTON, N.J. — A health care insurance contract’s anti-assignment provision clearly and unambiguously prevented an insured from transferring her rights under the plan to her provider, a federal judge in New Jersey held June 29 (Rahul Shah, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 16-5946, D. N.J., 2018 U.S. Dist. LEXIS 109703).
HOUSTON — Breach of contract, negligent misrepresentation and fraud claims arising from an insurer and employer’s alleged statements indicating that a plan covered 100 percent of a dental procedure do not meet the factors for Employee Retirement Income Security Act removal under Aetna Health Inc. v. Davila, a Texas federal judge held June 25 in remanding the case (Texas Oral and Facial Surgery PA v. United Healthcare Dental Inc., et al., No. 18-0944, S.D. Texas).
TRENTON, N.J. — An amended complaint largely “regurgitates” allegations previously rejected as insufficient and was likely authored not by the plaintiff, but the health care providers dismissed from the case, a health insurer and employer argue in a July 16 brief seeking dismissal of ERISA claims as well as attorney fees (Clifford Robinson v. Anthem Blue Cross Life and Health Insurance Co., et al., No. 17-4600, D. N.J.).
SANTA ANA, Calif. — Anti-assignment provisions preclude a plastic surgery center’s suit challenging denial of health insurance claims, and the provider lacks the necessary specificity to plead California unfair competition law (UCL) claims, an insurer says July 16 in asking a California federal judge to dismiss the claims (California Surgical Institute Inc. v. Aetna Life And Casualty [Bermuda] Ltd., et al., No. 17-310, C.D. Calif.).
ST. LOUIS — A membership-based emergency air transport’s contract is ambiguous as to whether it may recover only from health insurance or is entitled to recovery from broader insurance as well, and its apparent attempts at collecting the proceeds of a tort settlement are enough to permit some breach of contract and injunctive relief claims against it by one of its members alive, a federal judge in Missouri held July 16 (Doris Ergle Lindsey Pratt v. Air Evac Lifeteam, et al., No. 17-3097, W.D. Mo., 2018 U.S. Dist. LEXIS 117854).
YAKIMA, Wash. — Plaintiffs claiming that insurers engaged in a bait-and-switch scheme in which they advertised Affordable Care Act (ACA)-compliant plans but provided only “woefully little coverage” after enrollment may amend their complaint to drop those and other claims, a federal judge in Washington said July 17 while striking pending motions to dismiss the case (Cynthia Harvey, et al. v. Centene Corp., et al., No. 18-12, E.D. Wash.).
BOSTON — Medical records and communications predating a woman’s bulimia treatments and evidence of her long struggle with the disease were not part of an insurer’s process in denying her coverage and cannot be made part of the judicial record, a federal judge in Massachusetts said July 13 in denying a motion to expand the record in an ERISA case (Addie Fisher v. Harvard Pilgrim Health Care of New England Inc., No. 17-11232, D. Mass., 2018 U.S. Dist. LEXIS 116751).