News & Analysis as of

Insurance Claims Reimbursements Insurance Industry

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Davis Wright Tremaine LLP

Navigating Aetna's Expanded Claim Edits: What Providers Need To Know and Do Before September 1, 2025

Aetna recently announced that effective September 1, 2025, its Claim and Code Review Program (CCRP) will expand to include additional claim coding edits for all commercial, Medicare, and Student Health claims. While the...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

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Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Buchalter

I Just Lost My Home or Business to a Fire, What Do I Do Next?

Buchalter on

Take a deep breath. Losing one’s home or business to a fire is devastating and the road to recovery will be long and winding. First and foremost, you need to take care of yourself and your family. Make sure everyone is safe,...more

Rivkin Radler LLP

High-Profile Sports Insurance Fraud Rings: A Recent Conviction

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No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement...more

Rivkin Radler LLP

Insurance Update - December 2023

Rivkin Radler LLP on

Our December Insurance Update features a few firsts from state high courts. For the first time: •The Supreme Court of Hawaii addresses reimbursement of defense costs. •The Supreme Court of Illinois addresses coverage for...more

White and Williams LLP

Top Developments October 2023

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DEFENSE COST REIMBURSEMENT - Cont’l Cas. Co. v. Winder Labs., LLC, 73 F.4th 934 (11th Cir. 2023) Eleventh Circuit predicts that, under Georgia law, insurers found to have no duty to defend underlying suits could not...more

Marshall Dennehey

Fourth District Court of Appeals Reverses Itself Regarding Application of the 2007 Medicare Part B Non-Facility Limiting PIP...

Marshall Dennehey on

Progressive Select Ins. Co. v. In House Diagnostic Services, Inc. a/a/o Darryl Frazier, No. 4D21-2581 - This suit involved the legal issue of whether Progressive Select Insurance Company incorrectly determined the...more

Lowenstein Sandler LLP

Finding the Right Fit: The Duty to Defend vs. the Duty to Reimburse (Part II)

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Hosts Lynda A. Bennett and Eric Jesse of Lowenstein’s Insurance Recovery Group continue their discussion about the difference between the duty to defend, the duty to reimburse, and the duty to advance. They run through the...more

Lowenstein Sandler LLP

The Difference between the Duty to Defend and the Duty to Reimburse: What Policyholders Need to Know

In this episode of “Don’t Take No for an Answer,” hosts Lynda A. Bennett and Eric Jesse of Lowenstein’s Insurance Recovery Group discuss the difference between a duty to defend versus a duty to reimburse. They explain why...more

Pillsbury Winthrop Shaw Pittman LLP

Hurricane Ian: Insurance Implications

Hurricane Ian struck Florida on September 28. By late afternoon, it was a Category 5 storm with top winds of 155 miles per hour, producing huge storm surges along a wide area of the state’s southwestern coast. Damage is...more

Alston & Bird

Class Action & MDL Roundup – Winter 2021

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Welcome back to the Class Action & MDL Roundup! Our winter edition covers notable class actions from the fourth quarter of 2020. In this edition, we find a common theme among COVID-19 class actions, the Tampa 2 defends...more

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