cmonfils | December 29, 2010
www.hr.cch.com
CCH® BENEFITS — 12/23/10
from Spencer’s Benefits Reports: Twenty-six individuals and organizations responded to a request for comments on operational issues associated with implementation of a federal external claims review process in states that do not have their own external review process.
Public Health Service Act Sec. 2719(b)(1), added by the Patient Protection and Affordable Care Act, and related regulations provide that the Department of Health and Human Services’ Office of Consumer Information and Insurance Oversight (OCIIO) and the Department of Labor’s Employee Benefits Security Administration (EBSA) are authorized to establish an external review process that is similar to a state external review process for group health plans and health insurance coverage if a state has not established such a process. (more…)
Category: Claims Review |
No Comments »
Tags:
cmonfils | December 29, 2010
www.online.wsj.com
DECEMBER 23, 2010
By RUSSELL ADAMS and AVERY JOHNSON
Members of the Screen Actors Guild recently read in their health plan’s newsletter that, beginning in January, almost 12,000 of its participants will lose access to treatment for mental-health and substance-abuse issues.
The guild’s health plan represents one of a small number of unions, employers and insurers that are scrapping such benefits for their enrollees because of a 2008 law that requires that mental-health and substance-abuse benefits, if offered, be as robust as medical or surgical benefits. By dropping such coverage, providers can circumvent the requirements. (more…)
Category: Mental Health Parity |
No Comments »
Tags:
cmonfils | December 29, 2010
www.laborandemploymentlaw.ncbar.org
Article Date: Friday, December 17, 2010
Written By: Robert Ward Shaw & Mark Stanton Thomas
The U.S. District Court for the Eastern District of North Carolina recently held that the Employee Retirement Income Security Act of 1974 (“ERISA”) precludes a plan administrator with a claim against the insured for amounts recovered from a third party for medical benefits from pursuing equitable remedies against the insured attorney’s contingency fee award. (more…)
Category: 4th, Common Fund, Subrogation |
No Comments »
Tags:
cmonfils | December 29, 2010
Single-payer proposal on Legislature’s menu
By Josh Goodman Stateline.org
Published: Sunday, December 26, 2010
WASHINGTON — Congress never really considered a single-payer health plan run by the government. Vermont is planning for one. This isn’t some liberal fantasy. Vermont lawmakers are serious. To understand how serious, you only have to look at the resumes of William Hsiao and Jonathan Gruber. (more…)
Category: Health Care Legislation, News, Vermont |
No Comments »
Tags:
Adam V. Russo | December 22, 2010
www.healthleadersmedia.com
Philip Betbeze, for HealthLeaders Media , December 13, 2010
About This Survey
The Healthcare Leaders Reform Readiness study was conducted by the HealthLeaders Media Intelligence Unit. It is part of a series of monthly Thought Leadership studies. In October 2010, an online survey was sent to the HealthLeaders Media Council and select members of the HealthLeaders Media audience. Respondents work in a variety of settings, including hospitals, physician organizations, health plans, insurers, government, education, and academic. A total of 289 completed surveys are included in the analysis. The margin of error for a sample size of 289 is +/- 5.8 percentage points. A detailed report and analysis can be found online after December 15, at www.healthleadersmedia.com/intelligence/. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 22, 2010
www.kentucky.com By JOSH GOODMAN Dec 20, 2010
WASHINGTON — Congress never really considered a single-payer health plan run by the government. Vermont is planning for one. This isn’t some liberal fantasy. Vermont lawmakers are serious. To understand how serious, you only have to look at the resumes of William Hsiao and Jonathan Gruber. (more…)
Category: Vermont |
No Comments »
Tags:
Adam V. Russo | December 22, 2010
www.insurancenewsnet.com December 17, 2010
Health Reform Law Pays For More Certified PPACA & ERISA Claim Specialists – More Healthcare Experts Ready To Cash In On New Patient’s Bill of Rights Hanover Park, Illinois (Vocus/PRWEB).
On December 15, 2010, ERISAclaim.com entered an agreement with Yolanda Flores Corporation on Healthcare PPACA & ERISA Claims Specialist Certification training, as the nation’s first generation of PPACA Claims Specialists. New federal claims and appeals regulation went into effect on September 23, 2010, with an enforcement grace period until July 2, 2011, for all group health plans and individual policies in claims reimbursement and denials. Currently, healthcare providers and health plans must substantially comply with existing ERISA claim regulation of 36 years. Beginning 2011, under new health reform law, all non-grandfathered plans must “strictly” and completely adhere to existing ERISA regulations as well as six new requirements for internal appeals and new federal external appeals process. (more…)
Category: ERISA, Health Care Legislation, PPACA |
No Comments »
Tags:
Adam V. Russo | December 22, 2010
www.dorsey.com December 13, 2010
Today, a federal district court ruled in Virginia v. Sibelius that an important part of the Patient Protection and Affordable Care Act (the “Act”) was unconstitutional. The case is one of several constitutional challenges from states, public interest groups, and other opponents filed since Congress passed health care reform earlier this year. These plaintiffs have argued that Congress exceeded its constitutional authority by including in the Act an individual mandate provision requiring the uninsured to pay a penalty unless they had individual or employer-sponsored health insurance. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 20, 2010
MyHealthguide, www.myhealthguide.com
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 12/13//2010 www.StopLossLaw.com
Case: Diversatek,Inc. v .QBE Ins. Corp. and SLG Benefits and Insurance., LLC, No. 07-C-1036, in the United States District Court for the Eastern District of Wisconsin, 11/30/2010). Court’s Opinion.
Mr. Croft’s Comment: I represent the carrier and MGU in this case, in which proceedings are ongoing. For that reason, my commentary on the case will be brief, and will stick to reporting the holdings of the Court without comment or argument at this time. In other words, my tongue bleeds profusely throughout this write up. (more…)
Category: Stop Loss |
No Comments »
Tags:
Adam V. Russo | December 15, 2010
Smeal College of Business, Jun 10, 2010,
http://research.smeal.psu.edu/news/no-private-health-insurance
In the wake of the federal health care overhaul, large companies are investigating the advantages of dropping medical care as an employee benefit. A recent article in Fortune magazine, for example, notes that internal documents subpoenaed by Congress indicate that AT&T, Caterpillar, John Deere, and Verizon all were considering eliminating the health care coverage they currently provide to their workers and paying a penalty fee to the government instead. They are doing the math and beginning to recognize that there are cost savings associated with the dropping of health care as a benefit. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 15, 2010
Business Insurance December 13, 2010
By: Joanne Wojcik
Group health plan cost increases picked up steam in 2010 after several years of relative stability, and the health care reform law is expected to help that surge continue in 2011.
Higher medical fees and increased utilization caused group health care plan costs to jump an average of 6.9% in 2010, the largest increase since 2004, according to Mercer L.L.C. That brought average annual costs to $9,562 per employee vs. $8,945 in 2009, according to the annual survey. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 15, 2010
Business Insurance December 13, 2010
By: Jerry Geisel
Business Insurance’s top story of 2010—enactment of comprehensive health care reform legislation—will continue to play out in 2011 and beyond.
The March passage of the legislation, President Barack Obama’s signature domestic issue, came after more than a year of legislative maneuvering. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 15, 2010
Business Insurance December 13, 2010
DURING A RECENT HEARING, Senate Commerce Committee Chairman John D. Rockefeller IV, D-W.Va., asked whether mini-med plans are doing consumers more harm than good.
That’s a fair question. The plans, which typically are offered to low-wage, part-time or temporary employees, have little resemblance to mainstream employer-provided health care plans. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 15, 2010
Business Insurance, December 13, 2010
By: Joanne Wojcik
Whenever I attend a health benefits conference that addresses wellness issues, I often am greeted with a bit of envy because I come from what many consider to be the fittest state in the union. It’s generally assumed that everyone who lives in Colorado is into mountaineering, bicycling or skiing, depending on the time of year. But while Colorado may have the lowest obesity rate in the nation at 18.9%, it is questionable whether that alone is enough to lower the prevalence of chronic disease in the population. In reality, access to health insurance and health care has a much bigger effect, regardless of how much one weighs. (more…)
Category: Health Care Legislation |
No Comments »
Tags:
Adam V. Russo | December 14, 2010
By Roy Harmon III, www.healthplanlaw.com
Thus, in a nutshell, Blue Cross lowered rates for its own subsidiary by effectively raising them for Flagstar and other self-insured plans. The letter agreements between Blue Cross and the hospitals spell out these facts in black and white.
But that does not mean that Flagstar knew about the deals. To the contrary, Blue Cross has admitted (in interrogatory responses in this case) that it never told Flagstar it had raised the Plan’s rates in order to lower them for its own subsidiary. And it appears that Flagstar was otherwise clueless about the change, because Blue Cross did not provide backup data for the bottom-line charges it sent Flagstar each month. (more…)
Category: Fiduciary Liability |
No Comments »
Tags:
