SANTA ANA, Calif. — Anti-assignment provisions preclude a plastic surgery center’s suit challenging denial of health insurance claims, and the provider lacks the necessary specificity to plead California unfair competition law (UCL) claims, an insurer says July 16 in asking a California federal judge to dismiss the claims (California Surgical Institute Inc. v. Aetna Life And Casualty [Bermuda] Ltd., et al., No. 17-310, C.D. Calif.).
ST. LOUIS — A membership-based emergency air transport’s contract is ambiguous as to whether it may recover only from health insurance or is entitled to recovery from broader insurance as well, and its apparent attempts at collecting the proceeds of a tort settlement are enough to permit some breach of contract and injunctive relief claims against it by one of its members alive, a federal judge in Missouri held July 16 (Doris Ergle Lindsey Pratt v. Air Evac Lifeteam, et al., No. 17-3097, W.D. Mo., 2018 U.S. Dist. LEXIS 117854).
YAKIMA, Wash. — Plaintiffs claiming that insurers engaged in a bait-and-switch scheme in which they advertised Affordable Care Act (ACA)-compliant plans but provided only “woefully little coverage” after enrollment may amend their complaint to drop those and other claims, a federal judge in Washington said July 17 while striking pending motions to dismiss the case (Cynthia Harvey, et al. v. Centene Corp., et al., No. 18-12, E.D. Wash.).
BOSTON — Medical records and communications predating a woman’s bulimia treatments and evidence of her long struggle with the disease were not part of an insurer’s process in denying her coverage and cannot be made part of the judicial record, a federal judge in Massachusetts said July 13 in denying a motion to expand the record in an ERISA case (Addie Fisher v. Harvard Pilgrim Health Care of New England Inc., No. 17-11232, D. Mass., 2018 U.S. Dist. LEXIS 116751).
CAMDEN, N.J. — Third Circuit U.S. Court of Appeals precedent recently confirmed the validity of anti-assignment clauses in the Employee Retirement Income Security Act setting, and a health insurer’s interactions with a provider during the administrative appeals process did not waive the defense, a federal judge in New Jersey held July 13 (Rahul Shah, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 17-166, D. N.J.).
WASHINGTON, D.C. — A Medicare Advantage insurer cherry-picks quotes and misrepresents precedent in an attempt to avoid the very real conflict regarding whether noncontracted providers must exhaust of administrative remedies prior to filing suit, a hospital group tells the U.S. Supreme Court in a July 10 brief (Atlanta Medical Center Inc., et al. v. Care Improvement Plus South Central Insurance Co., No. 17-1283, U.S. Sup.).
MADISON, Wis. — A Wisconsin federal judge received reply briefs July 9, laying before him the issue of whether a health insurance plan’s exclusion on cosmetic vaginoplasties discriminates against transgendered individuals and violates the Patient Protection and Affordable Care Act (ACA) and the U.S. Constitution (Alina Boyden and Shannon Andrews v. Wisconsin Department of Employee Trust Funds, et al., No. 17-264, W.D. Wis.).
JACKSONVILLE, Fla. — A federal judge in Florida on July 5 adopted a magistrate judge’s report, dismissing breach of contract claims against an insurer brought by a hospital group but saying a state law claim survived (Southern Baptist Hospital of Florida Inc., et al. v. Celtic Insurance Co., etc., No. 17-1214, M.D. Fla.)
CHICAGO — A liquidation procedure involving a Patient Protection and Affordable Care Act (ACA) nonprofit health insurer is exactly the type of proceeding where Congress defers to states, a federal judge in Illinois held July 2 in once again finding that the case should be remanded (Melissa Dowling v. United States Department of Health and Human Services, No. 17-494, N.D. Ill., 2018 U.S. Dist. LEXIS 110554).
SAN FRANCISCO — The Patient Protection and Affordable Care Act (ACA) recognizes lactation support services as preventive care and does not carve out situations where women receive the services in response to symptoms, a federal judge in California held in partially granting judgment to named class members on ACA and ERISA claims June 27 (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).
SAN FRANCISCO — States have not shown that federal regulations expanding moral and religious exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate would result in any women turning to them for coverage or that the rules would impact state budgets in any way, two intervenors and the federal defendants told the Ninth Circuit U.S. Court of Appeals on June 11 in arguing that the plaintiffs lack standing (California, et al. v. Alex M. Azar II, et al., Nos. 18-15144, 18-15166, 18-15255, 9th Cir.).
WASHINGTON, D.C. — Crisis pregnancy centers are likely to prevail on the merits of their challenge to a California law imposing certain disclosures on similar providers, a 5-4 majority of the U.S. Supreme Court held June 26 (NIFLA, et al. v. Xavier Becerra, et al., No. 16-1140, U.S. Sup.).
WASHINGTON, D.C. — An appeals court properly recognized the difference between contracted Medicare providers and non-contracted providers in requiring exhaustion of administrative remedies prior to filing suit, an insurer told the U.S. Supreme Court June 22 (Atlanta Medical Center Inc., et al. v. Care Improvement Plus South Central Insurance Co., No. 17-1283, U.S. Sup.).
LOS ANGELES — Medicare doesn’t preempt a hospital group’s breach of contract action alleging that an insurer downcoded claims in an effort to underpay on bills, a federal judge in California held June 22 (Prime Healthcare Services Inc. v. Humana Insurance Co., et al., No. 16-1097, C.D. Calif.).
SALT LAKE CITY — The Employee Retirement Income Security Act preempts a hospital group’s claims alleging underpayment of medical bills, but the claims would fail in any case because they involve insurer-insured rights and cannot be assigned to third parties, an insurer tells a federal judge in Utah in a June 15 memo (IHC Health Services Inc., et al. v. Blue Cross and Blue Shield of Texas Inc., No. 18-277, D. Utah).
FORT WORTH, Texas — Striking down the Patient Protection and Affordable Care Act (ACA) because the government will no longer impose sanctions for not complying with the law’s individual mandate would harm public health and the economy and do violence to the separation of powers, a slew of medical, legal, business, economic, and social benefit amici argue in briefs filed in a federal court in Texas on June 14 (Texas, et al. v. U.S.A., et al., No. 18-167, N.D. Texas).
BIRMINGHAM, Ala. — A man musters “no authority even remotely” suggesting that personal jurisdiction can arise from simply registering to do business in a state, a federal judge in Alabama held June 13 in dismissing Patient Protection and Affordable Care Act (ACA) and other claims against hospital entities for allegedly failing to provide a deaf man with an interpreter (Teddy Beasley v. Providence Hospital, et al., No. 18-0004, S.D. Ala., 2018 U.S. Dist. LEXIS 99572).
WASHINGTON, D.C. — The U.S. Supreme Court on June 18 declined to review a ruling by Oklahoma’s top court finding an insured’s class action challenging a health care provider’s billing practices outside of the Employee Retirement Income Security Act’s preemptive powers (INTEGRIS Health Inc. v. Elizabeth Cates, et al., No. 17-1501, U.S. Sup.).
WASHINGTON, D.C. — Health insurers may not collect billions in Patient Protection and Affordable Care Act (ACA) risk-corridor funds because Congress specifically blocked payments, a majority of the Federal Circuit U.S. Court of Appeals said June 14 (Land of Lincoln Mutual Health Insurance Co. v. United States, Moda Health Plan Inc. v. United States, Nos. 2017-1224, 2017-1994, Fed. Cir.).
TRENTON, N.J. — A spine center’s Employee Retirement Income Security Act suit seeking hundreds of thousands of dollars from a health insurance plan offered by an Ohio insurer and administered in that state should be litigated in the state as well, a New Jersey federal judge held in transferring the case June 12 (University Spine Center v. Anthem Blue Cross and Blue Shield, No. 17-8676, D. N.J., 2018 U.S. Dist. LEXIS 97947).