News & Analysis as of

Third-Party Health Insurance

ArentFox Schiff

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

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A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...more

Maynard Nexsen

Tri-Agency FAQ Provides Updated Guidance Regarding Compliance with the Gag Clause Prohibition

Maynard Nexsen on

On January 14, 2024, the Departments of Labor, Health and Human Services, and the Office of Personnel Management (the “Departments”) jointly released the FAQs About Consolidated Appropriations Act, 2021 Implementation Part 69...more

Jackson Lewis P.C.

Conjuring Health Plan Hygiene: The Final Chapter

Jackson Lewis P.C. on

As we conclude our “Health Plan Hygiene” blog series, we reflect on the important insights shared about fiduciary responsibilities under the Employee Retirement Income Security Act of 1974 (ERISA) and highlight the risk posed...more

Jackson Lewis P.C.

Health Plan Hygiene Part 4 – Show Me the Money

Jackson Lewis P.C. on

Our “health plan hygiene” series has focused on steps that fiduciaries of employer-sponsored group health plans can take to ensure they meet their fiduciary responsibilities. This issue has been brought to the forefront...more

Ballard Spahr LLP

Prescription for Chaos: Copay Accumulator Programs Called Into Question

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Summary - Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more

Foley & Lardner LLP

Upcoming Deadline Under The No Surprises Act – Air Ambulance Reporting By Group Health Plans and Insurance Issuers

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Air ambulance services often result in large, unanticipated medical bills for patients. A study by the Government Accountability Office found that in 2017, 69% of air ambulance transports provided to individuals covered by...more

Littler

“Medical Necessity” Isn’t Well-Defined Unless It Is Well-Defined

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A U.S. District Court in Connecticut recently issued an order that highlights the importance of understanding exactly what the term “medically necessary” means in an ERISA health plan....more

Seyfarth Shaw LLP

ERISA Preemption — The Courts of Appeal Continue to Rule As They Await Further Supreme Court Attempts To Define, Once and for All,...

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Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more

Robinson+Cole Health Law Diagnosis

D.C. Circuit Court of Appeals Allows HHS Rule that Includes Payments Received from Third Parties in DSH Payment Cap Calculation

On August 13, 2019 the D.C. Circuit Court of Appeals (the D.C. Circuit) issued an opinion in Children’s Hospital Association of Texas v. Azar (No. 18-5135), allowing the Department of Health and Human Services (HHS) to...more

Parker Poe Adams & Bernstein LLP

Managed Care Narrow Networks

Narrow networks (managed care provider networks that include a limited choice of participating healthcare providers and suppliers) have been widely criticized by consumers and consumer-rights groups, particularly in light of...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - October 2015

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Editor's Overview - This month, we review the Second Circuit's ruling in New York State Psychiatric Ass'n, Inc. v. UnitedHealth Grp. wherein the Second Circuit ruled that: (i) a provider association has associational...more

Zelle  LLP

Employee Health Information: Separate and Secure

Zelle LLP on

There are several reasons an employer might have employee health information, ranging from the results of a pre-employment physical to the contents of a request for FMLA leave to what’s written in a health provider’s note...more

McDermott Will & Emery

IRS Adjusted ACA Fee Amounts for the 2015/2016 Policy or Plan Years and Additional Payment Options

McDermott Will & Emery on

The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance...more

Foley & Lardner LLP

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

Foley & Lardner LLP on

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

BakerHostetler

Waivers of Co-Pays and Deductibles: Insurance Benefit Exclusions Grow

BakerHostetler on

Recent changes to policy and plan language and increased litigation by third-party payers suggests that out-of-network providers who waive co-pays and deductibles may be in for some rough sailing. Providers must be aware of...more

Proskauer - Employee Benefits & Executive...

Agencies Issue Final Regulations on the Summary of Benefits and Coverage (SBC) Requirements

As promised in the FAQ issued on March 30, 2015, the U.S. Departments of the Treasury, Labor and Health and Human Services (the Departments) have issued final regulations regarding the summary of benefits and coverage (SBC)...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - February 2013

Proskauer Rose LLP on

In This Issue: - Editor's Overview - View from Proskauer: Are Your Conversations Privileged under ERISA? - Rulings, Filings, and Settlements of Interest ...more

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