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Mealey's Health Care / ACA

  • June 12, 2019

    Judge Dismisses State Law, ERISA Claims In Provider’s Health Insurance Suit

    TRENTON, N.J. — A health care provider’s state law claims require consulting an Employee Retirement Income Security Act plan and are preempted, and the ERISA claims themselves are barred by an anti-assignment provision, a federal judge in New Jersey held May 23 in dismissing the case (East Coast Advanced Plastic Surgery v. Aetna Inc., et al., No. 18-9429, D. N.J., 2019 U.S. Dist. LEXIS 86941).

  • June 11, 2019

    Little Sisters Tell Top Court New Developments Show Need For ACA Review

    WASHINGTON, D.C. — A recent federal district court judge’s ruling in favor of Patient Protection and Affordable Care Act (ACA) contraceptive mandate objectors furthers the case for U.S. Supreme Court review of an issue plaquing lower courts, a petitioner tells the court in a June 10 supplemental brief (Little Sisters of the Poor Jeanne Jugan Residence v. California, et al., No. 18-1192, U.S. Sup.).

  • June 11, 2019

    Judge Rejects Insurer’s ‘Ludicrous’ Surprise Bill Argument, Motion To Dismiss

    NEW YORK — An insurer’s contention that an out-of-network provider never alleges that a stroke sufferer inquired into the availability of in-network emergency surgery is “ludicrous and offensive,” and the procedure clearly falls within the policy’s surprise bill exception to the anti-assignment provision, a federal judge in New York held May 15 in denying a motion to dismiss (Jeffrey Farkas, M.D. LLC v. Group Health Inc., No. 18-8535, S.D. N.Y., 2019 U.S. Dist. LEXIS 83096).

  • June 7, 2019

    Judge: Insurer Shorted Period For Medically Necessary Mental Health Treatments

    SALT LAKE CITY — A federal judge in Utah on June 4 affirmed complete denial of coverage for treatment at one mental health treatment facility under the Employee Retirement Income Security Act, but found treatment at a second medically necessary for longer than the insurer allowed (Mike G., et al. v. BlueCross BlueShield of Texas, No. 17-347, D. Utah., 2019 U.S. Dist. LEXIS 94291).

  • June 7, 2019

    Mental Health Parity Claim Fails For Lack Of Comparison, Judge Says

    SALT LAKE CITY — Even assuming that an insurer erred in denying coverage for inpatient mental health care, plaintiffs lack sufficient comparison to other instances where the insurer approved coverage in other settings to support a Mental Health Parity and Addiction Equity Act claim, a federal judge in Utah held June 5 (Kerry W. and N.W. v. Anthem Blue Cross and Blue Shield, No. 19-67, D. Utah).

  • June 5, 2019

    6th Circuit Affirms Insurer’s HIV Drug Policy Isn’t Discrimination

    CINCINNATI — The Patient Protection and Affordable Care Act (ACA) limits a plaintiff to the standard governing the type of discrimination he is alleging and he may not pick and choose which statute’s standard he wishes to apply, a Sixth Circuit U.S. Court of Appeals panel held June 4 (John Doe v. BlueCross BlueShield of Tennessee Inc., No. 18-5897, 6th Cir., 2019 U.S. App. LEXIS 16785).

  • June 4, 2019

    Class Certification Denied In ACA Lactation Support Insurance Case

    SAN FRANCISCO — Three proposed classes in a Patient Protection and Affordable Care Act (ACA) case challenging insurance coverage for lactation specialists are overly broad, and while Employee Retirement Income Security Act allegations are less problematic, they too are overly broad and do not make clear the relief that could be granted, a federal judge in California said May 23 in denying class certification (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

  • June 3, 2019

    Government Wants Association Health Plan Ruling Reversed

    WASHINGTON, D.C. — States lack standing to challenge a Patient Protection and Affordable Care Act (ACA) rule expanding association health plans, and in any case, a judge erred in finding the rule did “violence” to the Employee Retirement Income Security Act (ERISA) definition of an employer, the Department of Labor tells the District of Columbia Circuit U.S. Court of Appeals in an opening brief May 31 (New York, et al. v. U.S. Department of Labor, et al., No. 19-5125, D.C. Cir.).

  • June 3, 2019

    Insurer Appeals After Entry Of $123,849 Judgment In ERISA Benefits Case

    SEATTLE — An insurer on May 31 noticed an appeal challenging a $123,849 judgment awarded to plaintiffs who prevailed in their case claiming improper denial of residential treatment under the Employee Retirement Income Security Act (Todd R., et al. v. Premera Blue Cross Blue Shield of Alaska, No. 17-1041, W.D. Wash.).

  • May 31, 2019

    Insurer Stands Pat In Medicaid Fair Hearing Supreme Court Challenge

    WASHINGTON, D.C. — The Kentucky Supreme Court erred in concluding that a Medicaid recipient’s lack of financial interest left her without standing to a pursue a fair hearing as required by a federal program, a woman argues in a May 15 petition asking the U.S Supreme Court for a writ of certiorari.  The insurer on May 29 told the court that it would not respond to the petition (Lettie Sexton, et al. v. Commonwealth of Kentucky, et al., No. 18-1446, U.S. Sup.).

  • May 30, 2019

    Judge Approves Settlement In Behavioral Health Care Reimbursement Case

    BOULDER, Colo. — A federal judge on May 24 granted a motion for fees, costs and final approval to a settlement resolving claims that an insurer reimbursed out-of-network providers of behavioral health care differently than in-network providers (Laural O’Dowd, et al. v. Anthem Inc., et al., No. 14-2787, D. Colo., 2019 U.S. Dist. LEXIS 88292).

  • May 29, 2019

    Insurer Objects, But Judge Adopts Report Keeping State Law Health Care Claims

    FORT LAUDERDALE, Fla. — An out-of-network health care provider’s state law claims will proceed after a federal judge in Florida on May 28 issued a one-page order adopting a report and recommendation over the objections of the insurer (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).

  • May 24, 2019

    Insurers: United States Ignores Adverse Impact Of Risk-Corridor Ruling

    WASHINGTON, D.C. — The United States never grapples with the disastrous consequences and far-reaching impact a decision allowing the government to simply skip out on Patient Protection and Affordable Care Act (ACA) risk-corridor obligations, a pair of insurers tell the U.S. Supreme Court in reply briefs filed May 22 and May 24 (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.).

  • May 24, 2019

    California Says New Rule Sanctions Health Care Discrimination, Violates ACA

    SACRAMENTO, Calif. — A newly issued rule permits doctors and staff to deny basic health care based on hunches, violating federal and state laws ensuring patient safety and access to care, the state of California claims in a May 21 complaint (State of California, et al. v. Alex M. Azar, et al., No. 19-2769, N.D. Calif.).

  • May 23, 2019

    Judge Sanctions Drug Testing Company Over Corporate Witness Readiness

    FRANKFORT, Ky. — A health care provider must pay for an insurer’s costs in preparing for a second deposition after its original corporate witness’s near total failure to prepare, a federal judge in Kentucky said May 21 (PremierTox 2.0 Inc. v. Coventry Health and Life Insurance Co., No. 15-127, W.D. Ky., 2019 U.S. Dist. LEXIS 85017).

  • May 17, 2019

    11th Circuit: Procedure Errors Don’t Alter Standard; Insurers’ ERISA Ruling Stands

    ATLANTA — Insubstantial procedural errors do not require anything other than the capricious and arbitrary standard in an Employee Retirement Income Security Act case challenging an insurer’s denial of coverage for eating disorder treatments, an 11th Circuit U.S. Court of Appeals panel held May 15 (O.D. v. Jones Lang LaSalle Medical PPO Plus Plan, No. 17-13060, 11th Cir., 2019 U.S. App. LEXIS 14385).

  • May 16, 2019

    Federal Judge Frees Payment Processor From Insurance Payment Dispute

    EVANSVILLE, Ind. — A company tasked with paying health insurance claims cannot be liable in a hospital’s case against the issuer of a stop-loss policy, a federal judge in Indiana said May 13 (Memorial Hospital and Health Care Center v. Houston International Insurance Group, et al., No, 18-225, S.D. Ind., 2019 U.S. Dist. LEXIS 80522).

  • May 15, 2019

    Federal Judge Continues Receivership Over FTC-Targeted Health Insurer

    MIAMI — Defendants portrayed health insurance products as comprehensive plans compliant with the Patient Protection and Affordable Care Act (ACA) when in reality they offered little to no coverage, a federal judge in Florida held May 14 in granting a motion for injunction, asset freeze and continued receivership (Federal Trade Commission v. Simple Health Plans LLC, et al., No. 18-62593, S.D. Fla.).

  • May 14, 2019

    Religious Order, California Face Off Before Supreme Court In ACA Rules Appeal

    WASHINGTON, D.C. — The Supreme Court again confronts the question of whether the Patient Protection and Affordable Care Act (ACA)’s contraceptive mandate infringes on religious objectors’ rights under federal law, as it receives dueling briefs in the latest development in the litigation.  California filed its response to the Supreme Court petition for certiorari review on May 13 (Little Sisters of the Poor Jeanne Jugan Residence v. California, et al., No. 18-1192, U.S. Sup.).

  • May 13, 2019

    United States Says Congress Never Finalized ACA Cost-Sharing Payments

    WASHINGTON, D.C. — Congress never appropriated funds for the Patient Protection and Affordable Care Act (ACA) cost-sharing reduction program and, thus, never created a duty to make those payments, the United States tells a U.S. Court of Federal Claims judge in a May 9 reply (Blue Cross And Blue Shield of North Dakota v. The United States, No. 18-1983C, Fed. Clms.).

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