FORT LAUDERDALE, Fla. — Failure to exhaust administrative remedies provides an absolute bar to Employee Retirement Income Security Act claims, and there is no evidence that the provider’s services conferred a benefit on the insurer, dooming the remainder of the case, a federal magistrate judge in Florida said Aug. 14 (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).
LOS ANGELES — Aetna Life Insurance Co. asked a federal judge in California on Aug. 13 for dismissal of what remains of an Employee Retirement Income Security Act case as a sanction for health care providers’ failure to comply with a court deadline for settlement negotiations (Infoneuro Group, et al. v. Aetna Life Insurance Co., No. 16-5083, C.D. Calif.).
CHICAGO — A federal judge in Illinois on Aug. 13 held that she lacked jurisdiction over a case filed by an insolvent health insurer’s liquidator against the Centers for Medicare and Medicaid Services (CMS) and the U.S. government in which the liquidator sought to have an offset payment system be declared unlawful (Kevin Fry v. Centers for Medicare and Medicaid Services, et al., No. 19-1320, N.D. Ill., 2019 U.S. Dist. LEXIS 136175).
JACKSONVILLE, Fla. — Collateral estoppel prevents a woman from pursuing breach of contract claims in a health insurance coverage case, and conduct regulated by the office of insurance is exempt from the state’s unfair competition law, a Florida appeals court held Aug. 13 (Meghan Hotchkiss v. Blue Cross and Blue Shield of Florida Inc., No. 1D17-4097, Fla. App., 1st Dist., 2019 Fla. App. LEXIS 12382).
BROOKLYN, N.Y. — Simply arguing that a health insurer could have or should have covered residential mental health treatments is not enough to support an Employee Retirement Income Security Act suit, a federal magistrate judge in New York said July 30 (Samuel Halberg, et al. v. United Behavioral Health, et al., No. 16-6622, E.D. N.Y., 2019 U.S. Dist. LEXIS 128966).
ST. LOUIS — The Patient Protection and Affordable Care Act (ACA) cannot simultaneously require coverage for lactation services while permitting insurers to place administrative barriers that make obtaining that care impossible, two women tell the Eighth Circuit U.S. Court of Appeals in an Aug. 7 reply brief (Jillian York, et al. v. Wellmark Inc., et al., No. 19-1705, 8th Cir.).
BOSTON — Even on the expanded record required by the First Circuit U.S. Court of Appeals, the evidence does not support the conclusion that a woman’s residential mental health treatments met the definition of medically necessary care, a federal judge in Massachusetts held Aug. 7 (Jane Doe v. Harvard Pilgrim Health Care Inc., et al., No. 15-10672, D. Mass.).
PHOENIX — Allegations that hospital defendants repeatedly ignored or redirected a couple’s requests for an interpreter, rendering communication impossible, support claims for discrimination under the Patient Protection and Affordable Care Act (ACA) and other federal laws, a federal judge in Arizona held in an order granting summary judgment entered Aug. 6 (Daniel Bustos, et al. v. Dignity Health, et al., No. 17-2882, D. Ariz., 2019 U.S. Dist. LEXIS 129969).
NEW HAVEN, Conn. — Claims seeking payment for emergency air ambulance transport between Puerto Rico and Florida from a host insurer are misdirected, lack evidence that the defendants intentionally induced conduct or are preempted, a federal judge in Connecticut held Aug. 5 in dismissing them (Estate of Carol A. Kenyon v. L+M Healthcare Health Reimbursement Account, et al., No. 19-93, D. Conn.).
SALT LAKE CITY — Failure to adequately follow an insurer’s procedures for obtaining out-of-network coverage dooms a suit seeking benefits covering a mental health treatment facility, a federal judge in Utah held July 25 (Robert O., et al. v. Harvard Pilgrim Health Care Inc., et al., No. 17-1251, D. Utah).
CHARLOTTE, N.C. — A deaf man’s discrimination claims fail where there is evidence that the medical facility attempted to meet his needs, and the claims’ demise also dooms his Patient Protection and Affordable Care Act (ACA) claim, a federal judge in North Carolina held July 23 (Neil Basta v. Novant Health Inc., et al., No. 19-64, W.D. N.C.).
TRENTON, N.J. — Though unhappy with a court’s conclusion that the Employee Retirement Income Security Act and an anti-assignment provision squelch most of its suit, a health care provider offers no new evidence and is stuck with the ruling, an insurer told a federal judge in New Jersey July 22 (Sleep Tight Diagnostic Center, et al. v. Aetna Inc., et al., No. 18-3556, D. N.J.).
ST. LOUIS — A patient did not assign Employee Retirement Income Security Act equitable relief rights to an emergency air transport provider, and nothing in the allegations requires that the insurer pay the full bill, an Eighth Circuit U.S. Court of Appeals panel held July 23 (Air Evac EMS Inc. v. USAble Mutual Insurance Co., et al., No. 18-2264, 8th Cir., 2019 U.S. App. LEXIS 21938).
BOSTON — Whether a health plan covers an adolescent’s residential treatment requires a deeper dive into the facts, a federal judge in Massachusetts said July 19 in permitting an Employee Retirement Income Security Act benefit claim and saying dismissing the equitable relief at this stage of the litigation was premature (Brent S., et al. v. Blue Cross Blue Shield of Massachusetts Inc., No. 17-11569, D. Mass., 2019 U.S. Dist. LEXIS 120415).
TRENTON, N.J. — A sleep study provider’s claims are largely preempted by the Employee Retirement Income Security Act, and there is insufficient evidence that the insurer’s conduct waived anti-assignment provisions, a federal judge in New Jersey held June 28 (Sleep Tight Diagnostic Center, et al. v. Aetna Inc., et al., No. 18-3556, D. N.J.).
SAN FRANCISCO — Allegations that an insurer improperly reduced reimbursement rates in the mental health context largely support a woman’s claims invoking the Employee Retirement Income Security Act and federal law, but she cannot avoid that the Patient Protection and Affordable Care Act (ACA) leaves enforcement of an anti-discrimination provision to the government, a federal judge in California held July 18 (Jane Smith v. United Healthcare Insurance Co., No. 18-6336, N.D. Calif., 2019 U.S. Dist. LEXIS 120151).
TRENTON, N.J. — An anti-assignment provision prevents a surgery provider from becoming an Employee Retirement Income Security Act beneficiary, and nowhere does it allege a colorable claim under the law, a federal judge in New Jersey said July 16 in adopting a magistrate judge’s report and recommendation (East Coast Advanced Plastic Surgery v. Blue Cross Blue Shield of Texas, et al., No. 19-6175, D. N.J.).
WASHINGTON, D.C. — Rules expanding short-term limited duration health plans do not exceed agency authority and do not conflict with the Patient Protection and Affordable Care Act (ACA), a federal judge in the U.S. District Court for the District of Columbia said July 19 (Association for Community Affiliated Plans, et al. v. United States Department of Treasury, et al., No. 18-2133, D. D.C., 2019 U.S. Dist. LEXIS 120834).
WASHINGTON, D.C. — Months after the defendants waived their right to respond to a petition for certiorari and the case was set for conference, the U.S. Supreme Court on July 18 asked for a response in a case challenging an insured’s right to a hearing under Medicaid (Lettie Sexton, et al. v. Commonwealth of Kentucky, et al., No. 18-1446, U.S. Sup.).
PORTLAND, Maine — Federal rules requiring separation between Title X services and abortion services remain in place after a federal judge in Maine denied an injunction on July 3, while suggesting that although he didn’t believe the policy made much sense, it was not his place to play “Oracle of Delphi heroically saving the republic” (The Family Planning Association of Maine, et al. v. United States Department of Health and Human Services, et al., No. 19-100, D. Maine, 2019 U.S. Dist. LEXIS 111164)