A recent decision from the US District Court for the Eastern District of New York has significant implications for providers navigating the No Surprises Act (NSA) independent dispute resolution (IDR) process....more
Within the last month, the US District Court for the Northern District of California rejected efforts by United Behavioral Health (UBH) to dismiss and decertify two class actions seeking relief related to UBH’s processing of...more
California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms....more
1/31/2025
/ Artificial Intelligence ,
California ,
Class Action ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
New Legislation ,
Physicians ,
Regulatory Agenda
Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more
In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions...more
On December 5, 2022, the US District Court for the Middle District of North Carolina held that the North Carolina State Health Plan (NCSHP) constitutes a “Health Program or Activity” under the Affordable Care Act (ACA). In so...more
12/14/2022
/ Affordable Care Act ,
Bostock v Clayton County Georgia ,
Civil Rights Act ,
Employee Retirement Income Security Act (ERISA) ,
Gender Discrimination ,
Health Insurance ,
North Carolina ,
Rulemaking Process ,
SCOTUS ,
Summary Judgment ,
Transgender
In December, the Supreme Court requested that U.S. Solicitor General Elizabeth Prelogar file a brief in John Doe 1 v. Express Scripts Inc., weighing in on whether the Court should hear a case about prescription drug costs. If...more
2/8/2022
/ Amicus Briefs ,
Drug Pricing ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Health Insurance ,
Healthcare ,
Petition for Writ of Certiorari ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
SCOTUS
Below are six reimbursement issues that health care providers should be on “high alert” for as the COVID-19 crisis persists.
An increasing number of patients will be losing their health insurance coverage....more
Lawmakers remain in negotiations among the three key committees in the House of Representatives: Energy & Commerce, Ways & Means, and Education & Labor, along with the Senate Committee on Health, Education, Labor and Pensions...more
The US Court of Appeals for the Third Circuit recently confirmed that “anti-assignment” provisions — provisions prohibiting insureds from assigning their rights under a health plan to third parties, including medical...more