The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Video: Getting Ready for the No Surprises Act - Thought Leaders in Health Law
A federal appeals court just illustrated the importance of an employer’s duty to monitor service providers that assist with the administration of employee welfare benefit plans. In the May 21 decision of Tiara Yachts v. Blue...more
Welcome to the strange and mysterious world of medical billing. If ever there was an industry in which the charges and the payments have no correlation, the medical industry is it. Medical billing can indeed be quite...more
On September 9, 2024, the U.S. Department of Labor (the “DOL”), the U.S. Department of the Treasury and the U.S. Department of Health and Human Services (“HHS”) jointly released regulations entitled “Requirements Related to...more
The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules....more
The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more
Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more
On May 31, the Ninth Circuit Court of Appeals published an opinion in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, which has significant implications for the healthcare industry, most notably by...more
The Biden administration has announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our prior article for more information). A topic of great...more
The “law of unintended consequences” describes the general sociological principle that for every action there is an unintended or unanticipated outcome. An influential examination of the concept was published in 1936 by...more
Summary: For Health Plans, Machine-Readable Files, containing in-network provider charges and out-of-network allowed amounts and billed charges, must be posted on a public website by July 1, 2022....more
On our last visit to The Hill, we reported on the buzz surrounding the government’s efforts to end health care surprise billing and create more transparency in billing practices. Not long after that visit in 2020, the Biden...more
In one of the biggest attempts by the federal government to combat surprise medical billing, Congress in late 2020 passed the No Surprises Act (NSA), which imposes a host of new transparency and coverage requirements for...more
Group health plan sponsors soon will face daunting new disclosure and transparency requirements under multiple laws including the Affordable Care Act (ACA), the No Surprises Act (the Act) and the Consolidated Appropriations...more
On July 1, 2021, the Office of Personnel Management, Department of the Treasury, Department of Health and Human Services (“HHS”), and Department of Labor (“DOL”) (collectively, the “Departments”), released the interim final...more
The U.S. Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management have issued "Requirements Related to Surprise Billing; Part I," an interim final rule to implement the No...more
The Ninth Circuit significantly limited insurers' ability to rely on anti-assignment provisions in ERISA health plans in Martin Luther King, Jr. Community Hospital v. Community Insurance Company dba Anthem Blue Cross Blue...more
In July, we reported (here) on a Third Circuit decision that held an out-of-network provider’s direct claims against an insurer for breach of contract and promissory estoppel were not pre-empted by ERISA. That opinion was a...more
Anti-assignment clauses in ERISA health plans are useful to plan sponsors in fending off lawsuits by out-of-network providers. Federal courts have consistently upheld anti-assignment provisions contained in the plan document...more
As many have likely heard, multiple COVID-19 vaccine candidates have rapidly reached the final stages of development and are showing extraordinary effectiveness. The vaccines are beginning to be submitted to the FDA for...more
Seyfarth Comments: The final Transparency in Coverage Rule was published jointly by the Departments of Health and Human Services, Treasury, and Labor on November 12, 2020. The Rule aims to increase transparency in...more
In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more
The Centers for Medicare & Medicaid Services (CMS) issued FAQ guidance encouraging health insurers to relax their utilization management and prior authorization requirements in view of the COVID-19 pandemic while at the same...more
The Third Circuit recently held that anti-assignment clauses in ERISA-governed healthcare plans are enforceable as long as they are unambiguous. The Court concluded that the anti-assignment clause clearly stated that...more
The Northern District of California recently considered a case brought by a hospital against a self-funded health plan claiming the underpayment of out-of-network claims (Salinas Valley Memorial Healthcare System vs. Rocket...more
Recently, the U.S. Court of Appeals for the Third Circuit handed the insurance industry a small victory by holding that, in American Orthopedic & Sports Med. v. Indep. Blue Cross Blue Shield, unambiguous anti-assignment...more