SALT LAKE CITY — A health insurer and plan must produce documents related to an insured’s mental health treatments and how they determine medical necessity in that setting as well as surgical settings, a federal judge in Utah said Dec. 2 in reserving rulings on motions to dismiss and to amend a complaint (James C., et al. v. Anthem Blue Cross and Blue Shield, No. 19-38, D. Utah).
SALT LAKE CITY — Debts incurred when a health insurer denied coverage for a child’s treatments provide the parents with standing, but their attempts to recover the amount through the Mental Health Parity and Addiction Act rely on conclusory statements and are better addressed by the Employee Retirement Income Security Act, a federal judge in Utah said Nov. 21 (John R., et al. v. United Behavioral Health, et al., No. 18-35, D. Utah).
SALT LAKE CITY — A health insurer cannot avoid discovery in a case alleging that its improperly denied coverage for mental health and substance abuse treatment simply because there is a pending summary judgment motion, a federal magistrate judge held Nov. 21 (Robert L., et al. v. Cigna Health & Life Insurance Co., et al., No. 18-976, D. Utah, 2019 U.S. Dist. LEXIS 202914).
NEW ORLEANS — A medical provider’s suit seeking compensation for what it claims are the rates an insurer agreed to pay for insured’s treatments alleges the type of independent obligation separate from the Employee Retirement Income Security Act plan, a federal judge in Louisiana said Nov. 18 (Crescent City Surgical Center v. United Healthcare of Louisiana, et al., No. 19-12586, E.D. La., 2019 U.S. Dist. LEXIS 199009).
SALT LAKE CITY — Allegations that a health insurer applied different standards for medical necessity in the mental health realm compared to traditional surgical and medical procedures adequately allege a violation of federal law, a federal judge in Utah said Nov. 18 (Peter E., et al. v. United Healthcare Services Inc., et al., No. 17-435, D. Utah, 2019 U.S. Dist. LEXIS 200603).
WASHINGTON, D.C. — Seeking to prevent the injustice that would arise from preventing an insurer from collecting post-judgment interest on nearly $18 million to which a court found it was entitled under the Patient Protection and Affordable Care Act (ACA) cost-sharing program for years 2017 and 2018, a federal judge on Nov. 18 granted partial final judgment (Local Initiative Health Authority for L.A. Co, et al. v. The United States, No. 17-1542C, Fed. Clms., 2019 U.S. Claims LEXIS 1779).
PORTLAND, Ore. — A federal judge on Nov. 13 granted in part a motion to stay and extend case deadlines pending a settlement in a case challenging compensation from a health insurer (Dwayne Brandon v. Health Net Health Plan of Oregon Inc., No. 19-356, D. Ore.).
HARTFORD, Conn. — The secretary of Health and Human Services in an Oct. 31 post-trial brief tells a Connecticut federal court that a class of Medicare recipients have no protected property interest and no “state action” concerning the classification of their hospital services under Medicare rules (Christina Alexander, et al. v. Alex M. Azar II, No. 11-1703, D. Conn.).
HONOLULU — An out-of-network provider’s letter indicating that it would bill patients if an insured does not pay its rates did not create a contract between the parties, and the lack of any contract dooms the insurer’s action, a federal judge in Hawaii said in dismissing the case with prejudice on Oct. 31 (Kaiser Foundation Health Plan Inc. v. The Queen’s Medical Center Inc., et al., No. 19-301, D. Hawaii, 2019 U.S. Dist. LEXIS 189386).
SEATTLE — Catholic health plan defendants will cover autism behavior therapy without exclusion or limitation and create an $800,000 fund reimbursing class members for out-of-pocket expenses under the terms of a settlement for which plaintiffs sought preliminary approval on Nov. 4 (J.R., et al. v. Blue Cross and Blue Shield of Illinois, et al., No. 18-01191, W.D. Wash.).
WASHINGTON, D.C. — A handful of amicus curiae parties on Nov. 1 urged the U.S. Supreme Court to take up the Patient Protection and Affordable Care Act (ACA) contraceptive mandate case (Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, et al., Donald J. Trump, et al. v. Pennsylvania, Nos. 19-431, 19-454, U.S. Sup.).
LOS ANGELES — California Patient Protection and Affordable Care Act (ACA) exchange plans fall outside state law governing arbitration clauses, and individuals who enrolled in health plans outside the exchange have not shown that the arbitration agreement violated the law, a California appeals court held Nov. 1 (Paul Simon, et al. v. Blue Cross of California, No. B292118, Calif. App., 2nd Dist., 2019 Cal. App. Unpub. LEXIS 7324).
WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on Oct. 31 dismissed for lack of jurisdiction insolvent insurer liquidators’ state law claims against the U.S. government over violation of South Carolina insurance law following the government’s offset of $36 million under the reinsurance program of the Patient Protection and Affordable Care Act (ACA) (Raymond G. Farmer, et al. v. The United States, No. 18-1484, Fed. Clms., 2019 U.S. Claims LEXIS 1584).
MIAMI — A proton beam coverage class action’s differences from one filed a month prior in Massachusetts involving cervical rather than prostate cancer are not so great that transfer is not warranted, a federal judge in Florida said Oct. 28 (Richard Cole, et al. v. United HealthCare Insurance Co., No. 19-21258, S.D. Fla.. 2019 U.S. Dist. LEXIS 187358).
DALLAS — Texas laws governing payment for emergency care lack a private right of action and doom an air transport company’s suit, a federal magistrate judge in Texas held Oct. 4 in overriding a magistrate judge’s recommendations (Apollo MedFlight LLC v. BlueCross BlueShield of Texas, No. 18-166, N.D. Texas, 2019 U.S. Dist. LEXIS 172927).
SAN FRANCISCO — A health care plan violated the Employee Retirement Income Security Act when it failed to notify insureds that the plan no longer offered in-network dialysis providers, a move that violated Medicare rules when prohibiting discrimination, and the assignment of “any cause of action” provides legal standing to pursue the claims, a provider tells the Ninth Circuit U.S. Court of Appeals in an Oct. 23 opening brief (DaVita Inc., et al. v. Amy’s Kitchen Inc., et al., No. 19-15963, 9th Cir.).
WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) never appropriated funds for the risk corridor, and congressional action later limited how the program would function, dooming insurers’ suit seeking billions of dollars from the government, an amicus curiae told the U.S. Supreme Court on Oct. 25 on the heels of the government’s Oct. 21 respondent brief (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 18-1038, Moda Health Plan Inc., et al. v. United States, No. 18-1028, Maine Community Health Options v. United States, No. 18-1023, U.S. Sup.).
ATLANTA — An insurer with discretionary authority did not err when it denied coverage for two-level spinal fusion surgery under the plan’s exclusion on experimental procedures, an 11th Circuit U.S. Court of Appeals panel held Oct. 24 in rejecting an Employee Retirement Income Security Act claim (Sharon Pierce v. Wyndham Worldwide Operations Inc., et al., No. 19-11079, 11th Cir., 2019 U.S. App. LEXIS 31746).
WASHINGTON, D.C. — A federal claims judge on Oct. 22 awarded a class of health insurers nearly $1.6 billion in Patient Protection and Affordable Care Act (ACA) cost-sharing reduction payments for 2017 and 2018 (Common Ground Healthcare Cooperative v. The United States, No. 17-877, Fed. Clms.).
GRAND RAPIDS, Mich. — Because a health insurer’s agent never signed a proposed settlement with an emergency air transport company, no formal agreement exists, the provider cannot claim to have relied on later statements in providing the service and the Employee Retirement Income Security Act preempts the lone other claim, a federal judge in Michigan held Oct. 2 (Air Trek Inc. v. Capital Steel & Wire Inc., et al., No. 17-1145, W.D. Mich., 2019 U.S. Dist. LEXIS 171716).