Mealey's Health Care / ACA

  • December 11, 2019

    Utah Federal Judge Considers Wilderness Therapy Parity Act Claim

    SALT LAKE CITY — A federal judge in Utah on Dec. 10 heard arguments about whether a family adequately pleaded that an insurer improperly denied coverage for wilderness therapy and withheld judgment on the insurer’s motion to dismiss the Mental Health Parity and Addiction Act claim (Candace B., et al. v. Blue Cross and Blue Shield of Rhode Island, No. 19-39, D. Utah).

  • December 10, 2019

    Insurers, Government Battle Over ACA Risk-Corridor Payments

    WASHINGTON, D.C. — The U.S. Supreme Court heard arguments on Dec. 10 about whether the Patient Protection and Affordable Care Act (ACA)’s “shall pay” language created a financial obligation for the government or at all times remained contingent on later congressional funding (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.).

  • December 10, 2019

    Surgery Provider’s Suit Seeking Payment From Insurers Survives Dismissal

    ALAMEDA, Calif. — A surgery provider’s preauthorization conversations with insurers led it to believe it that would be paid its usual and customary rates, a federal judge in California said Nov. 20 in denying a motion to dismiss (California Spine and Neurosurgery Institute v. Oxford Health Insurance Inc., et al., No. 19-3533, N.D. Calif., 2019 U.S. Dist. LEXIS 202556).

  • December 10, 2019

    Magistrate Judge Says Medical Provider’s Suit Belongs In State Court

    TRENTON, N.J. — The record is largely silent as to whether a medical provider has valid assignments from insureds, and even if it had standing under the Employee Retirement Income Security Act, its claims do not directly involve such a plan, a federal magistrate judge in New Jersey said Nov. 25 in recommending remand (North Jersey Brain & Spine Center v. United Healthcare Insurance Co., et al., No. 18-15631, D. N.J.).

  • December 10, 2019

    Judge: Medical Transport Prevails Against Authorization, Necessity Arguments

    CHICAGO — Only a health plan’s participating providers must obtain preauthorization for nonemergency transport, and absent evidence of a closer qualified provider, there exists no reason to conclude that air transport to the facility in question was not medically necessary, a federal judge in Illinois held Nov. 26 (Aviation West Charters LLC v. Health and Welfare Plan for Employees of Anjinomoto USA Inc., et al., No. 18-7431, N.D. Ill., 2019 U.S. Dist. LEXIS 204908).

  • December 05, 2019

    Judge Orders Insurer To Turn Over Documents In Mental Health Coverage Spat

    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).

  • November 26, 2019

    Judge Finds Standing But Not Sufficient Allegations In Parity Act Case

    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).

  • November 26, 2019

    Discovery Moves Forward In Health Coverage Spat While Court Considers Judgment

    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).

  • November 21, 2019

    Contracted Rate Allegations Escape ERISA Removal, Federal Judge Finds

    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).

  • November 21, 2019

    Disparate Mental Treatment Allegations Satisfy Parity Act Standard, Judge Says

    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).

  • November 21, 2019

    Judge:  Entering Partial Final Judgment Avoids Injustice In ACA Cost-Sharing Case

    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).

  • November 18, 2019

    Parties Settle Health Insurance Payment Spat After Case Survives Dismissal Motion

    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.).

  • November 13, 2019

    HHS Secretary: No Protected Interest For Class Over Medicare Hospital Designation

    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.).

  • November 12, 2019

    Lack Of Contract Between Insurer, Provider Dooms Health Care Action, Judge Says

    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).

  • November 07, 2019

    Autism Therapy Coverage Class Seeks Preliminary Approval Of Settlement

    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.).

  • November 06, 2019

    Amicus Parties Urge Supreme Court Review Of ACA Mandate Case

    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.).

  • November 05, 2019

    Health Insurance Switch Claims Must Go Before Arbitration, California Court Says

    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).

  • November 04, 2019

    Part Of Liquidator’s Claims Over Offset Under ACA Reinsurance Program Dismissed

    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).

  • October 31, 2019

    Florida Proton Beam Coverage Case Heads North Under First-Filed Rule

    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).

  • October 28, 2019

    Federal Judge Rejects State Law Analysis, Clips Air Transport Suit Claims

    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).

Can't find the article you're looking for? Click here to search the Mealey's Health Care / ACA archive.