According to hospital officials in multiple states, Anthem Blue Cross is behind on billions of dollars in payments to hospitals because of new reimbursement rules, computer problems, and mishandled claims—this according to an...more
Health plans are using both new and old methods to deny healthcare providers’ claims, all of which are legally and factually unsupportable. These tactics have repeatedly been rejected by arbitrators in scores of arbitrations,...more
The California Court of Appeal in Los Angeles recently took up the issue of whether federal and/or state law sets any rate for Medicaid MCOs to pay to hospitals for out-of-network post-stabilization services. The case was...more
Under the Employee Retirement Income Security Act (“ERISA”), health care providers can file legal actions to recover employee benefits if they obtain a proper assignment of the patient’s benefits. Increasingly, however, ERISA...more
Health Plans’ Use of Policies and Guidelines to Reduce Coverage and Reimbursement -
A technique we have seen payers use more commonly in recent months than in the past is to unilaterally implement policies or “clinical...more