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Insurance Industry › Denial of Insurance Coverage › Health Insurance

Maynard Nexsen

Keeping an Eye Out for Litigation Involving Increasingly Popular Gap Coverage

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So-called “gap” insurance policies – policies that provide critical-illness, hospital-indemnity and specified-disease coverage – have been on the rise due to a number of factors, including the frequency of high-deductible...more

Arnall Golden Gregory LLP

Federal Court Certifies Class Action Against Blue Cross Blue Shield of Montana for Improperly Denying Large Dollar Claims

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The Chief Judge of the U.S. District Court for the District of Montana recently certified a class action against Blue Cross Blue Shield of Montana for its standard operating procedure of reviewing and denying claims in...more

Arnall Golden Gregory LLP

UnitedHealthcare Must Face State Law Claims in Class Action Suit for AI Driven Coverage Denials of Medicare Advantage Claims

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Daytime television inundates American seniors with advertisements for UnitedHealthcare’s (“UHC”) Medicare Advantage Plans. On its website, UHC claims its Medicare Advantage Plans “stand out from the rest,” providing...more

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

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In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more

Wiley Rein LLP

Tenth Circuit Deems D&O Policy Ambiguous Based on Interplay of Coverage Grant with Managed Care Exclusion

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The United States Court of Appeals for the Tenth Circuit, applying Kansas law, has held that a D&O insurer was obligated to reimburse defense costs where a policy expressly covered antitrust claims but excluded coverage for...more

Hall Benefits Law

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

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A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

McDermott Will & Schulte

[Webinar] Gender-Affirming Benefits: Best Practices for Group Health Plans - February 29th, 1:00 pm - 1:30 pm EST

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Employers and plan sponsors are facing growing – and often conflicting – pressures related to the coverage of gender-affirming care. Join McDermott lawyers Sarah G. Raaii and Alden J. Bianchi for a webinar to review recent...more

Arnall Golden Gregory LLP

Preemption and Exhaustion Requirements Thwart Medicare Advantage Plan Members’ Ability to Hold Health Insurers Accountable

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Most states have statutes or common law that allow an insurance policyholder to bring a civil action and seek more than just compensatory damages (e.g., punitive damages) when her insurance company denies coverage in bad...more

K&L Gates LLP

Recent District Court Decision Highlights the Importance of Adequate Behavioral Health Claims Processing Guidelines for ERISA...

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On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more

Foley & Lardner LLP

Behavioral Health & Substance Abuse Services: Massachusetts Proposal Reflects Focus on Expanding Access and Coverage

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... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more

Farrell Fritz, P.C.

Medical Marijuana 104: Responsibilities of Health Insurers

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It will come as no surprise that patients who are thinking about getting certified for medical marijuana use have a number of questions relating to the cost of obtaining medical marijuana products....more

BakerHostetler

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

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Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

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