Adam V. Russo | June 30, 2009
by Lisa Wangsness of The Boston Globe, www.boston.com
WASHINGTON – The face of the insurance industry in Washington is a slight, soft-spoken former AFL-CIO employee benefits director with a penchant for data-driven logic. She has the confidence and intellectual agility of a skilled debater, but prefers to dwell on areas of agreement. On healthcare, Karen Ignagni often sounds like the lifelong Democrat that she is. (more…)
Adam V. Russo | June 29, 2009
by Michelle Massey, Texarkana Bureau, http://www.setexasrecord.com
MARSHALL – After turning over nearly $400,000 to buy what they thought was an ERISA employee welfare benefit plan, two Virginia doctors believe they were the victims of an elaborate nationwide theft ring and are suing to get their money back. (more…)
Adam V. Russo | June 29, 2009
by Amanda Bronstad of The National Law Journal, www.law.com
An association representing the restaurant industry has filed a petition for writ of certiorari before the U.S. Supreme Court to overturn a ruling by the U.S. Court of Appeals for the 9th Circuit upholding a law requiring employers in San Francisco to provide health insurance to their employees. (more…)
Adam V. Russo | June 29, 2009
The ERISA Industry Committee, www.eric.org
Washington, D.C. — The ERISA Industry Committee (ERIC) earlier today submitted comments to the Department of Labor’s Employee Benefits Security Administration in response to a “request for information” regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). (more…)
Adam V. Russo | June 29, 2009
The ERISA Industry Committee, www.eric.org
Washington, D.C. — In a letter sent today to Members of the five congressional committees with jurisdiction over health care reform, The ERISA Industry Committee (ERIC), a Washington, D.C.-based trade association representing America’s major employers, expressed concern over proposals that could weaken the current employment-based health system.
Adam V. Russo | June 29, 2009
The ERISA Industry Committee, www.eric.org
Washington, D.C. — Michael Stapley, President and Chief Executive Officer of Deseret Mutual and Vice Chair of The ERISA Industry Committee, a Washington, D.C.-based trade association representing America’s largest employers, testified today before the House Education and Labor Committee where he urged Congress to first “do no harm” in seeking to reform the U.S. healthcare system. (more…)
Adam V. Russo | June 26, 2009
An inquiry by a TPA to the New York Insurance Department asked whether stop-loss insurers are subject to the prompt-pay rules of Insurance Law § 3224-a. In April 1982, the Insurance Department issued Circular Letter 7, which provides that stop-loss insurance is not reinsurance, but rather a form of accident and health insurance that may not be placed by excess line brokers. In 1999, the Legislature confirmed that stop-loss insurance is a form of accident and health insurance by enacting Insurance Law § 4237-a. (more…)
Adam V. Russo | June 26, 2009
Anderson v. Dergance, 2009 U.S. Dist. LEXIS 51593 (N.D. Ill. June 18, 2009)
This ERISA plan reimbursement case applies the Sereboff holding to find in favor of an ERISA plan’s claims to specifically identifiable funds held in an attorney’s trust account following a personal injury settlement. (more…)
Adam V. Russo | June 26, 2009
Many self-insured employers are concerned the Mental Health Parity Act may increase their healthcare costs. Currently, those most affected will be plans that now offer limited services or have high co-pays and deductibles. (more…)
Adam V. Russo | June 26, 2009
SIIA, www.siia.org
While Congress committees work, some members remain available: As committees in both the House and Senate closeted themselves in markup sessions and deliberations that prevented ordinary lobbying visits, SIIA engaged with three senators at two fundraising receptions. The first was in honor of Sen. Bob Bennett (R-UT), ranking member of the Senate Rules Committee. Also attending that event was Sen. John Thune (R-SD) of the Small Business and Entrepreneurship Committee. The next day we attended an event for Sen. Ben Nelson (D-NE) of the powerful Appropriations Committee. (more…)
Adam V. Russo | June 26, 2009
The Wall Street Journal, www.wallstreetjournal.com
The Senate Commerce Committee has found that a flawed payment database produced by a UnitedHealth subsidiary and distributed to other major insurance companies has led insurers to underpay millions of out-of-network claims, forcing patients to make up the difference of health care providers’ fees, the Wall Street Journal reports. Aetna, Cigna, WellPoint, and other large insurers used the data to calculate their “reasonable and customary” charges. They also provided UnitedHealth’s subsidiary, Ingenix, with historic data about their payments, which became the foundation of ongoing versions of the flawed payment models. (more…)
Adam V. Russo | June 25, 2009
by John Wood of ERISA and Disability Benefits Law Blog, www.erisaontheweb.com
Sherry DeLisle continued working after her car crashes in 1998 and 2000. She suffered spinal and closed head injuries. Her employer, Krandall & Sons, fired her on April 17, 2002, stating that “she was not doing her job.” Eight months later, DeLisle filed for long-term disability benefits with Sun Life, the insurer of Krandall’s disability plan. She submitted medical records and statements of five treating physicians. She listed April 17, 2002, as her date of disability. (more…)
Adam V. Russo | June 24, 2009
by John H. Eggertsen, Esq. and Michael Friedman, Esq. of SIIA, www.siia.org
I. District of Columbia’s Efforts to Regulate PBMs Preempted by ERISA
In their efforts to combat the ongoing initiatives on the part of several states to regulate the business activities of pharmacy benefit managers (“PBMs”), the PBMs recently won a skirmish. In Pharmaceutical Care Management Association v. District of Columbia, et al. 2009 WL 711771 (D.C.D.C.), a Federal District Court for the District of Columbia held that by regulating the relationship between PBMs and ERISA plans, the District of Columbia’s Access Rx Act of 2004 (the “Act”) “impermissibly intrudes upon a field exclusively reserved for federal regulation,” and thus, is preempted under ERISA. (more…)
Adam V. Russo | June 24, 2009
by Dave Kirby of SIIA, www.siia.org
Try talking while holding your breath
It’s been a long time between breaths. We’ve held ours, it seems, for months as we await the Congressional legislation that will purport to reform how health care operates in America- and, just incidentally, will likely chart the future course of our industry. (more…)
Adam V. Russo | June 24, 2009
by Tron Emptage of SIIA, www.siia.org
Self-insurers will soon face stiff consequences for failing to report Medicare eligible claims in a timely manner. This is due to changes to the Medicare, Medicaid and State Children’s Health Insurance Program (SCHIP) Extension act, which was signed into law in 2007. (more…)
