Adam V. Russo | December 29, 2008
In Avmed, Inc. V. BrownGreer, PLC, 2008 WL 4909535 (5th Cir. 2008), the 5th Circuit Court of Appeals hurt the health insurance subrogation industry when it comes to Vioxx claims. The court recognized that ERISA health plans have legitimate rights of subrogation and reimbursement for medical expenses paid to participants who suffered health issues after taking Vioxx, a drug intended to relieve pain.
The Court questioned whether settlement funds belonged to the subrogated plans and indicated that technical problems in mass tort multi-district litigation makes it difficult for plans to perfect their subrogation rights. (more…)
Category: 5th, Subrogation |
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Adam V. Russo | December 22, 2008
by Anna Wilde Mathews of The Wall Street Journal
You might expect to pay more if you choose a doctor outside your insurer’s network. But what if you don’t know a doctor’s status — or are in no position to ask? The result can be a nasty surprise known as balance billing.
Insured patients are sometimes hit with unforeseen charges after emergencies, when they are taken to the closest hospital regardless of whether the facility accepts their insurance. Consumers also may be billed after visiting in-network hospitals if they received treatment from medical providers who work there but don’t participate in the same health plans. When that happens, insurers often pay part of the doctors’ fees, and the physicians bill patients for the difference. This is the practice known as balance billing, and it can leave consumers battling both the insurer and the medical provider to get the charge reduced. (more…)
Category: News |
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Adam V. Russo | December 11, 2008
In April 2006, Massachusetts became the first state to require that all of its residents purchase health insurance. The plan had support from organizations and individuals across the political spectrum. The Massachusetts plan was a response to today’s health care costs, which are rising twice as fast as inflation, making insurance increasingly unaffordable for many employers and individuals. (more…)
Category: Massachusetts |
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Adam V. Russo | December 5, 2008
The leading health insurance trade group recently offered its own coverage proposal that calls for Congress to slow the growth of care costs by 30% in five years with a total savings of more than $500 billion.
America’s Health Insurance Plans (“AHIP”) stated that the money could be used to fund coverage of the uninsured and to cut costs for those with insurance. AHIP called on Congress to establish an advisory group to recommend action to reduce wasteful spending, change how providers are paid, and reducing administrative costs. (more…)
Category: News |
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Adam V. Russo | December 4, 2008
I recently received an email from a colleague of mine, James R. McKown, CEO of Recovery Data Connect, L.L.C., notifying me about a 9th circuit decision emphasizing three major factors in the case: plan language creating an automatic lien, rejecting the Made Whole Doctrine and preventing the plaintiff from challenging related medical claims due to a Sworn Declaration. To read the entire 9th circuit decision, Laborers v. Hill, United States District Court for the Northern District of California (November 25, 2008). Click Here
Category: 9th |
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Adam V. Russo | December 3, 2008
By Joanne Wojcik of Business Insurance, www.businessinsurance.com
The National Priorities Partnership is calling on all employers, health insurers, medical professionals, labor and government organizations and other interested parties to commit to a core list of six objectives its members believe will improve the quality of health care and lower costs within the next three to five years.
The six goals focus on improvements in patient and family engagement, population health, patient safety, care coordination, palliative and end-of-life care and overuse or misuse of health care resources. (more…)
Category: News |
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Adam V. Russo | December 3, 2008
By Joanne Wojcik of Business Insurance, www.businessinsurance.com
The growing popularity of consumer-driven health plans is influencing the size of deductibles in traditional preferred provider organization plans, a study concludes.
Meanwhile, the rate of increase in group health care plan costs showed little change from the past few years, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by New York-based consultant Mercer L.L.C. (more…)
Category: News |
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Adam V. Russo | December 3, 2008
In Gagliano v. Reliance Standard Life Ins. Co., 2008 WL 4916330 (4th Cir. 2008), an employee’s claim for long-term disability benefits was denied on the ground that she was not disabled under the terms of the plan. The court ordered an independent medical examination that stated the employee was disabled but the plan administrator (who was also the insurer) denied the claim on appeal based on the plan’s preexisting condition exclusion. (more…)
Category: 4th, 6th, Claims Review, ERISA |
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