We use cookies on this site to enable your digital experience. By continuing to use this site, you are agreeing to our cookie policy. close

Mealey's Health Care / ACA

  • January 16, 2019

    Surgery Provider, Aetna Butt Heads Over Payments For Out-Of-Network Care

    LOS ANGELES — The question of whether an anti-assignment provision precludes an out-of-network provider’s suit including California unfair competition law (UCL) claims or whether the insurer’s conduct waived the defense lays before a California federal judge after a Jan. 14 brief (California Surgical Institute Inc. v. Aetna Life and Casualty [Bermuda] Ltd., et al., No. 18-2157, C.D. Calif.).

  • January 15, 2019

    Pennsylvania Federal Judge Issues Nationwide Injunction In ACA Rules Challenge

    HARRISBURG, Pa. — Procedural issues and the harm rules expanding Patient Protection and Affordable Care Act (ACA) contraceptive mandate exemptions pose to states warrant an injunction, and the impossibility of crafting perfectly limited relief requires a nationwide injunction, a federal judge in Pennsylvania held Jan. 14 (Pennsylvania, et al. v. Donald J. Trump, et al., No. 17-4540, E.D. Pa.).

  • January 14, 2019

    California Court Rejects Social Service Provider’s Quest For ACA Insurance Costs

    SACRAMENTO, Calif. — A social services provider’s failure to exhaust administrative remedies before seeking tort recovery from the state for health insurance costs incurred under the Patient Protection and Affordable Care Act (ACA) warranted rejecting the suit, a California appeals court held Jan. 11 (Social Vocational Services Inc. v. Nancy Bargman, et al., No. C083251, Calif. App., 3rd Dist.).

  • January 14, 2019

    Federal Judge Enjoins Expansion Of ACA Contraceptive Mandate Exemptions

    SAN FRANCISCO — On the eve of their effective date, a federal judge in California enjoined rules expanding religious and moral exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, issuing a rare Sunday opinion on Jan. 13.  The defendants have already indicated that they will appeal the ruling. (California, et al. v. Don J. Wright, et al., No. 17-5783, N.D. Calif., 2018 U.S. Dist. LEXIS 13290).

  • January 11, 2019

    Residential Health Treatment Plaintiff Settles, Wants No-Notice Class Dismissal

    SEATTLE — A putative class’s claims involving insurance coverage for outdoor residential mental health treatment may be dismissed without notice because dismissal comes without prejudice and nothing precludes any proposed class member from pursing his or her own litigation, a lead plaintiff who recently resolved her own Employee Retirement Income Security Act claims against the insurer told a federal judge in Washington on Jan. 10 (A.Z., et al. v. Regence Blueshield, et al., No. 17-1292, W.D. Wash.).

  • January 11, 2019

    Mother Claims Insurer Improperly Denied Coverage For Residential Treatments

    SALT LAKE CITY — An insurer improperly denied benefits for residential treatment for a child with Asperger’s syndrome under the Employee Retirement Income Security Act, Patient Protection and Affordable Care Act (ACA) and laws governing mental health treatment, a woman alleged Jan. 9 after a judge allowed her to file an amended complaint over the objections of the insurer (Melissa P., et al. v. Aetna Life Insurance Co., et al., No. 18-216, D. Utah).

  • January 7, 2019

    High Court Passes On Anti-Assignment ACA Discrimination Case

    WASHINGTON, D.C. — The U.S. Supreme Court on Jan. 7 declined review of a case alleging an insurer discriminates against African-Americans and women providers under the Patient Protection and Affordable Care Act (ACA) by selectively enforcing anti-assignment provisions (W.A. Griffin v. Verizon Communications Inc., et al., No. 18-523, U.S. Sup.).

  • January 7, 2019

    Federal Judge: Lack Of Certified Interpreter Isn’t Discrimination

    DALLAS — A deaf and nearly blind woman’s complaint that an eye care provider failed to provide a certified interpreter does not adequately allege discrimination under the ADA or ACA, a federal judge in Texas held Jan. 3 (Jane Cummings v. Total Eye Care, No. 18-546, N.D. Texas, 2019 U.S. Dist. LEXIS 862).

  • January 7, 2019

    California Court: Patient Never Agreed To Pay Surgery’s $72,718.80 Cost

    LOS ANGELES — A patient who was told that his surgery would cost only what remained of his out-of-pocket insurance maximum did not enter into a contact with the provider to pay the entire $72,718.80 cost of his procedure, a California appeals court held Dec. 20 (Skull Base Medical Group v. Thomas Mallo, No. B287082, Calif. App., 2nd Dist., 2018 Cal. App. Unpub. LEXIS 8625).

  • January 3, 2019

    Couple Wants Delayed ERISA Surgery Benefits Action Reopened

    DETROIT — The passage of more than 100 days since a court remanded an Employee Retirement Income Security Act case for a benefits determination warrants finding administrative remedies exhausted and reopening a case, a couple tells a federal judge in Michigan in a Jan. 2 brief.  But in a response filed the same day, the insurer argues that a determination is forthcoming (Paul Zack, et al. v. McLaren Health Advantage Inc., No. 17-11253, E.D. Mich.).

  • January 2, 2019

    Judge Stays Case, Paving Way For Appeal Of ACA Constitutionality Ruling

    FORT WORTH, Texas — A federal judge in Texas entered final judgment on his ruling that Congress’ elimination of the penalty for individual mandate noncompliance rendered the entire Patient Protection and Affordable Care Act (ACA) unconstitutional and on Dec. 31 stayed the remainder of the case, paving the way for an appeal (Texas, et al. v. U.S.A., et al., No. 18-167, N.D. Texas).

  • December 21, 2018

    Judge Preliminarily Approves ACA Out-Of-Network Lactation Coverage Settlement

    WASHINGTON, D.C. — A federal judge in the District of Columbia on Dec. 12 granted preliminary approval to a class action settlement providing for full payment of out-of-pocket expenses allegedly incurred by a health insurer’s failure to cover comprehensive breastfeeding and lactation support counseling in violation of the Patient Protection and Affordable Care Act (ACA) (Lindsay Ferrer, et al. v. CareFirst Inc., et al., No. 16-2162, D. D.C.).

  • December 19, 2018

    Anti-Assignment Provision Largely Dooms Provider’s Health Care Reimbursement Case

    NEWARK, N.J. — An anti-assignment provision in a health care insurance contract is not subject to an alternative interpretation that could create ambiguity and was not waived, a federal judge in New Jersey held Dec. 14 in dismissing a provider’s case (Advanced Orthopedics and Sports Medicine Institute v. Anthem Blue Cross Life and Health Insurance Co., et al., No. 17-8848, D. N.J.).

  • December 18, 2018

    ACA, ERISA, UCL HIV Drug Discrimination Claims Fail, Judge Says

    SAN FRANCISCO — HIV/AIDS drug purchasers who allege that a health insurer violated their privacy and discriminated against them by requiring the use of mail order or pickup services fail to state claims under the Patient Protection and Affordable Care Act (ACA), California unfair competition law (UCL) or Employee Retirement Income Security Act, a federal judge in California held Dec. 12 (John Doe One, et al. v. CVS Pharmacy Inc., et al., No. 18-1031, N.D. Calif.).

  • December 18, 2018

    Debt Purchaser’s Claims Against Health Insurer Fail, Judge Says

    LOS ANGELES — A company appears to properly have purchased claims from medical providers, but it cannot show that the claims it pursues are covered by the purchase agreement, and it has not adequately pleaded its claims, a federal judge in California held Dec. 7 (Namdy Consulting Inc. v. UnitedHealthcare Insurance Co., No. 18-1283, C.D. Calif., 2018 U.S. Dist. LEXIS 208890).

  • December 18, 2018

    Individual Issues Prevent Class In Emergent Care Payment Cap Case, Court Says

    JACKSON, Tenn. — A trial court correctly concluded that individual issues predominate over a proposed class action challenging an insurer’s use of a $50 cap on reimbursement for nonemergency services provided in the emergency room, the majority of a Tennessee appeals court held Nov. 29 (Emergency Medical Care Facilities P.C. v. BlueCross BlueShield of Tennessee Inc., et al. No. W2017-02211-COA-R3-CV, Tenn. App., 2018 Tenn. App. LEXIS 695).

  • December 17, 2018

    Out-Of-Network Medical Provider’s Conspiracy Action Headed Back To State Court

    TRENTON, N.J. — An out-of-network medical provider’s “unique” conspiracy suit involving 14 causes of action against 17 defendants does not invoke the right to payment under the Employee Retirement Income Security Act and sufficiently alleges the existence of an independent legal duty, a federal judge in New Jersey held in remanding the action on Dec. 14 (North Jersey Brain & Spine Center v. MultiPlan Inc., et al., No. 17-5967, D. N.J., 2018 U.S. Dist. LEXIS 211272).

  • December 17, 2018

    9th Circuit Keeps, But Narrows, ACA Contraceptive Rules Injunction

    SAN FRANCISCO — A divided Ninth Circuit U.S. Court of Appeals on Dec. 13 partially upheld a ruling enjoining new Patient Protection and Affordable Care Act (ACA) contraceptive mandate exemptions expanding who can avoid the regulation, but said nonparty states could not be subject to the injunction (California, et al. v. Alex M. Azar II, et al., Nos. 18-15144, 18-15166, 18-15255, 9th Cir., 2018 U.S. App. LEXIS 35077).

  • December 17, 2018

    ACA Unconstitutional Absent Individual Mandate, Federal Judge In Texas Says

    FORT WORTH, Texas — A federal judge in Texas said striking the Patient Protection and Affordable Care Act (ACA) individual mandate renders the entire law unconstitutional under Supreme Court precedent.  The Dec. 14 ruling throws the law in doubt just as the window for enrollment closes for 2018 and means that the law is likely headed back to the Supreme Court (Texas, et al. v. U.S.A., et al., No. 18-167, N.D. Texas).

  • December 13, 2018

    Judge: Insurer Properly Denied Coverage For Residential Mental Health Treatments

    SAN FRANCISCO — A health insurer did not abuse its discretion in concluding that a California minor’s involuntary residential psychiatric treatment in Utah was not performed on an emergency basis or that her mother failed to properly investigate the potential for in-area, in-network care before the admission, a federal judge in California held Dec. 11 (Carol Meyers v. Kaiser Foundation Health Plan Inc., No. 17-04946, N.D. Calif.).