Adam V. Russo | January 28, 2009
December 2008, the Congressional Budget Office posted a healthcare analysis on budget options and key issues.
To see the budget options analysis click here
To see the key issues analysis click here
Adam V. Russo | January 28, 2009
Reminder:
Adam V. Russo, Esq. will be speaking about “The Road to TPA Success- Winning the Legal Battles in the Self Insured Industry” at the upcoming HCAA 2009 Annual Executive Forum on Thursday February 5th at 9am held at the Wynn Las Vegas Hotel in Las Vegas, NV.
Adam V. Russo | January 28, 2009
ERISA’S Impact on the Health Insurance Industry
Employer-based health insurance is the keystone of our health care system. Based on 2003 estimates, the Employee Retirement Security Act of 1974 (ERISA) placed the regulation of private sector employee health benefit plans under federal jurisdiction for roughly 131 million people.[i] ERISA applies to self-insured plans, while both ERISA and state authority apply to fully insured plans. The distinction is important since federal and state laws vary for subrogation. Roughly 67 million people are covered by self insured plans where the employer pays employees’ benefits directly, as opposed to traditional plans where 64 million have claims paid by insurers that collect premiums from employers.[ii] (more…)
Adam V. Russo | January 28, 2009
One of the biggest problem areas in the healthcare industry is the practice of balance billing of patients by non-participating providers for services reimbursed by the patient’s insurer at less than the provider’s billed charges. The providers’ demand to be paid the balance then becomes a point of contention in a three way battle between the provider, the patient and the insurer. The provider just wants to be paid its standard charge, the patient wants the insurer to cover whatever the patient owes, and the insurer wants to limit its outlay to the payment of a reasonable charge. (more…)
Adam V. Russo | January 21, 2009
Business Insurance Magazine
January 19, 2009
by Joanne Wojcik
Settlement over reimbursement rates could hit employers
NEW YORK-Employers likely will pay more for health care as a result of an agreement reached last week between New York’s attorney general and UnitedHealth Group Inc.
The agreement will see UnitedHealth spin off its Ingenix Inc. subsidiary’s databases used by most of the nation’s health insurers and third-party administrators to determine reimbursement rates for out-of-network providers. In a separate agreement, Aetna Inc. agreed to pay $20 million to help fund the new system. (more…)
Adam V. Russo | January 20, 2009
Florida Law Review
January 2009
by Jessie D. Puckett, Jr.
Click Here to See Entire Law Review Article
Adam V. Russo | January 16, 2009
The Supreme Court’s opinion in Black & Decker Disability Plan v. Nord, 538 U.S. 822(2003) did not hold that treating physician opinions can be neglected. This recent Eighth Circuit opinion demonstrates an application of an important piece of the Nord decision – that the administrator must take into account treating physicians’ opinions in reaching its conclusions. (more…)
Adam V. Russo | January 16, 2009
by The Associated Press
UnitedHealth Group Inc. will close much-criticized databases health insurers use to set payment rates and help launch a new one to settle a fraud investigation, which could help millions of patients pay less for ”out-of-network” care.
The Minnetonka, Minn.-based health insurer has agreed to pay $50 million to establish the new database, which will be run by a nonprofit organization like a university, according to a deal ironed out with the New York attorney general’s office. (more…)
Adam V. Russo | January 16, 2009
by Grace-Marie Turner of the New York Post
President-elect Barack Obama argued on the campaign trail that the US status quo in health care is untenable, citing the 46 million people who don’t have health insurance at any time as evidence. Like many others, he seems to believe the government should play a larger role.
Yet the United States already has an extensive system of taxpayer-financed medical care – and Obama should take a closer look at its strengths and failings.
In 2007, US health-care expenditures totaled more than $2.2 trillion – a sixth of our economy. New studies show that nearly half of that amount is paid via government programs. (more…)
Adam V. Russo | January 13, 2009
In a big win for attorneys representing children injured in car accidents, a federal court has ruled that an ERISA plan has no right to a subrogation lien for medical expenses when the minor’s settlement funds are placed in a special-needs trust.
Elizabeth Mills was seven months pregnant with Grace Mills when the car she was driving was struck at an intersection where the stop sign was allegedly obscured by foliage.
The impact caused serious injuries to Elizabeth Mills and her husband, Stephen Mills, and required the emergency premature delivery of Grace Mills, who now suffers from cerebral palsy due to a stroke at the time of her birth. (more…)
Adam V. Russo | January 5, 2009
McCauley v. First Unum Life Ins. Co., 2008 U.S. App. LEXIS 26094 (2nd Cir.) (December 24, 2008) is an important post MetLife v. Glenn decision in the Second Circuit. The Court found First Unum’s past history as being a factor in evaluating a conflict of interest.
The Court mentioned the fact that First Unum had a history of biased claims administration and how First Unum has a disturbing pattern of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics. The court listed more than thirty cases in which First Unum’s denials were found to be unlawful, including one decision in which First Unum’s behavior was “culpably abusive. (more…)
