Mealey's Health Care / ACA

  • March 30, 2022

    ERISA Class Suit Over Alleged Cross-Plan Offsetting Is Conditionally Dismissed

    BATON ROUGE, La. — Following a magistrate judge’s March 24 recommendation of a 60-day conditional order of dismissal because parties in the putative class action over alleged cross-plan offsetting “reached an agreement to resolve all claims,” a Louisiana federal judge on March 25 so ordered in a text-only docket entry.

  • March 29, 2022

    Partial Reversal In Class Suit Over Substance Use Disorder Care Draws Dissent

    PASADENA, Calif. — In a March 24 unpublished memorandum disposition, the Ninth Circuit U.S. Court of Appeals issued a partial reversal of a California federal court’s grant of dismissal for lack of standing in a putative class suit against a health insurer and related entities regarding substance use disorder care, with one panel member saying he would affirm dismissal as to all claims.

  • March 28, 2022

    Texas Top Court Wants Response In Emergency Care Compensation Claims Case

    AUSTIN, Texas — The Texas Supreme Court on March 25 asked for a response to hospitals’ petition arguing that the state’s emergency care laws create an implied right of action by mandating that insurers pay for specified care at specified rates and aren’t subject to exclusive jurisdiction of the Insurance Department.

  • March 28, 2022

    Supreme Court Denies Review In ACA-Medicaid Actuarial Soundness Case

    WASHINGTON, D.C. — The U.S. Supreme Court on March 28 denied a petition from states challenging the ACA-Medicaid actuarial soundness rule, with three justices saying that while threshold questions preclude granting review, the case raises important questions about the private nondelegation doctrine that the court should clarify in a future case.

  • March 25, 2022

    Provider Tells High Court ACA Claim Requires Intentional Discrimination

    WASHINGTON, D.C. — A court correctly affirmed summary judgment on a deaf woman’s Patient Protection and Affordable Care Act discrimination claim after finding evidence of intentional discrimination a requirement for nominal damages, a medical provider said in a March 15 brief while warning against “overstretching the statutes or undoing settled law.”

  • March 23, 2022

    9th Circuit Reverses Wilderness Therapy Claim Reprocessing Ruling

    SAN FRANCISCO — Allegations that an insurer improperly narrowed requirements for wilderness therapy coverage provide standing for an Employee Retirement Income Security Act class action, but the trial court improperly substituted its own interpretation of the plan for the insurer’s interpretation of how to handle generally accepted standards of care, a Ninth Circuit U.S. Court of Appeals panel said March 22 in reversing a ruling requiring the insurer to reprocess the coverage claims.

  • March 23, 2022

    Insurer Appeals Dismissal Of Insolvent Excess E&O Insurer’s Subrogation Claim

    KANSAS CITY, Kan. — An insurer assuming responsibility for Blue Cross Blue Shield of Kansas Inc.’s insolvent excess errors and omissions insurer on March 16 filed a notice in a Kansas federal court indicating that it was appealing the dismissal of a subrogation claim against Blue Cross Blue Shield Association in an antitrust coverage dispute.

  • March 22, 2022

    Judge Grants Argument Time For Discussion Of Texas Surprise Billing Ruling

    WASHINGTON, D.C. — After oral arguments on the proper methodology for calculating the qualified payment amount under the No Surprises Act, parties may debate the impact of a federal judge in Texas’ injunction, a federal judge in the District of Columbia said in a March 21 minute order.

  • March 21, 2022

    Amici Say Court Ignores Standard In Medicare Advantage Ruling

    WASHINGTON, D.C. — An appellate court “flouted basic standards of judicial review” and threatened the balance struck by the popular and critical Medicare Advantage system when it determined that the actuarial equivalence mandate did not apply to the overpayment provision and that even if it did, any error was so small as to be irrelevant, amicus curiae parties told the U.S. Supreme Court March 18.

  • March 18, 2022

    Judge Alters Judgment, Lets Insured Amend Therapy Coverage Action

    HARTFORD, Conn. — There is no evidence of undue delay or bad faith on the part of a man attempting to cure defects in his complaint alleging that his insurer improperly denied coverage for physical therapy he received after suffering a neurological condition, a federal judge in Connecticut said March 15 in finding that “manifest injustice” would result from denying the man’s motion to alter a judgment and amend his complaint.

  • March 18, 2022

    Judge Finds Standing, Jurisdiction Defects In Air Ambulance ERISA Suit

    TAMPA, Fla. — An air ambulance provider cannot rely on a lawyer’s power of attorney for standing to sue for Employee Retirement Income Security Act benefits, the attorney’s residence in Florida is unlikely to warrant venue in the state and the plaintiffs fail to cite the plan provision that would entitle them to benefits, a federal judge in Florida said March 16.

  • March 16, 2022

    Lack Of Administrative Appeals Dooms Hyperbaric Reimbursement Suit

    WEST PALM BEACH, Fla. — A federal judge in Florida on March 14 entered final judgment for an insurer, saying that despite a man’s protests that he filed appeals to the “extent humanly possible,” the fact remains that he largely failed to exhaust administrative remedies before bringing his Employee Retirement Income Security Act suit, and his conclusory belief that the insurer’s “emerging pattern” of denying claims made further attempts futile does not save his case.

  • March 16, 2022

    Blue Cross Moves For Judgment On The Pleadings In Antitrust Coverage Dispute

    KANSAS CITY, Kan. — Blue Cross Blue Shield of Kansas Inc. on March 10 moved for judgment on the pleadings in a Kansas federal court, challenging two claims in an antitrust coverage dispute involving an insolvent insurer.

  • March 15, 2022

    Insureds Again Ask Appeals Court To Revive California Parity Act Case

    SAN FRANCISCO — A judge misread precedent and the law itself in finding that an insurer met the requirements of the state’s Parity Act by offering coverage for mental health treatments even though its processes ensured that receiving such care was nearly impossible, insureds argue in a Jan. 28 opening brief to a California appeals court.

  • March 14, 2022

    Provider Sees COVID Test Payment Suit Largely Dismissed

    NEW HAVEN, Conn. — A provider of coronavirus testing largely saw its action against an insurer that allegedly denied more than 4,000 claims dismissed, after a federal judge in Connecticut on March 11 found that the laws responsible for creating the testing compensation system lacked a private right of action, that assignment of Employee Retirement Income Security Act claims were limited to benefits and that the balance of state law claims were preempted.

  • March 11, 2022

    Individual Health Insurance Policy Is Not Covered By ERISA, Judge Says In Dismissal

    CHICAGO — A health insurance policy that a business owner purchased for himself through a purported association of employers is not covered by the Employee Retirement Income Security Act, an Illinois federal judge ruled March 8, citing New York v. United States Department of Labor and dismissing a denial of benefits claim with prejudice.

  • March 10, 2022

    Judge Lets Deaf Man Testify As To Injury In ACA Case

    KNOXVILLE, Tenn. — A deaf man may testify about his foot injury, his symptoms, how they worsened, the resulting amputation and the distress he experienced, but may not testify about how any alleged failure to provide an interpreter led to that sequence of events, a federal judge in Tennessee said March 8 in granting a motion in limine in part.

  • March 10, 2022

    California High Court Won’t Publish Opinion Affirming Emergency Care Ruling

    LOS ANGELES — According to its docket, the California Supreme Court on March 9 declined to publish a lower court ruling addressing what the court portrayed as three issues of first impression about out-of-network hospitals’ ability to collect reimbursement from medical plans.

  • March 09, 2022

    Federal Judge Lets Deaf Man’s ACA Discrimination Case Proceed

    KNOXVILLE, Tenn. — A deaf man who had conceded he will not return to a hospital where he believes he suffered discrimination lacks standing for injunctive relief, but his allegations support his Patient Protection and Affordable Care Act discrimination claims against both the hospital and its parent company, a federal judge in Tennessee said March 8 in partly granting and partly denying the defendants’ motion for summary judgment.

  • March 08, 2022

    Teaching Hospitals Lose Bid To Revive Training Reimbursement Suit

    DENVER — Medicare did not permit shared reimbursement when three teaching hospitals incurred joint costs of offsite training and while the Patient Protection and Affordable Care Act changed that standard, its provision is prospective only, the 10th Circuit U.S. Court of Appeals said March 7.

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