Adam V. Russo | May 26, 2010
Very strange case where the plan participant never appears to defend herself against the efforts of the plan to obtain a judgment imposing a constructive trust or equitable lien against tort settlement proceeds. The case is ACS Recovery Services, Inc. v Kaplan, 2010 WL 144816 (N.D. Cal., Jan. 11, 2010) (more…)
Adam V. Russo | May 26, 2010
By Victor Lazzaro, Jr.
It’s important to examine the health care reform bill and how it will impact medical travel going forward. First, it should be understood that two bills passed on that historic March, 23, 2010 – the Senate bill and the “reconciliation” measure that changes significant aspects of the first bill. Depending on the outcome of subsequent changes “fixes” will probably continue for months, if not years, to come. One area that was not substantially crossed addressed in this legislation was structural cost reduction or pricing and quality transparency – akey advantage to using a medical travel facilitator. (more…)
Adam V. Russo | May 26, 2010
California regulators have filed suit to stop growing hospital chain Prime Healthcare Services from billing commercially-insured patients for fees that insurance companies don’t pay. The practice, known as balance billing, is explicitly forbidden in some states, but California law is vague on this topic, according to observers. However, Prime’s practices are so extreme in this regard that they must be stopped, according to the state’s Department of Managed Health Care (DMHC). This follows an earlier initiative by California Gov. Arnold Schwarzenegger (R), who has asked the DMHC to work out rules that would forbid balance billing for all ED services. The DMHC issued draft regulations banning the practice earlier this year. (more…)
Adam V. Russo | May 25, 2010
By Chris Carosa | May 18, 2010
Congress, regulators and the financial industry itself sit on the cusp of requiring all financial service providers who provide investment advice to adopt the fiduciary standard. Now is a great time for ERISA Plan Sponsors (as well as those who provide investment advice to ERISA plans or participants), to familiarize themselves with the nature of fiduciary duties. The anticipated change in the law may expose these officers and vendors to a fiduciary liability they might not have anticipated. (more…)
Adam V. Russo | May 24, 2010
By Liz Kowalczyk, The Boston Globe www.boston.com
Massachusetts health insurers say they want to freeze or slash payments to some hospitals and large physician groups this year, setting up the toughest contract negotiations in memory and creating the potential for disruptions in where patients get their care. Other providers would get small increases, at most. (more…)
Adam V. Russo | May 24, 2010
A few thoughts while I sit on a plane to Vegas to speak at a forum in the morning. Regardless of what many may think, employers will not stop health insurance coverage for their employees. It didn’t happen here in Massachusetts, even though employers – including Phia – could have. Why didn’t we stop offering health insurance even though it was cheaper to pay into the exchange? Because it is a benefit that is important to employees! Employers need employee benefits to recruit and retain top workers. (more…)
Adam V. Russo | May 24, 2010
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 5/20/2010, www.StopLossLaw.com
Case: Evangelical Presbyterian Church v. American Fidelity Assurance Company, et al., No. 08-116317, in the Circuit Court of Wayne County, Michigan, 5/14/2010). Court Opinion
Mr. Croft’s Comments: A Michigan trial court entered a 15 page Order granting summary judgment for a stop loss carrier and an MGU but denying summary judgment to the broker in a case involving disclosure issues. Because I represent the carrier and MGU in the case, and it is still ongoing, it would be inappropriate for me to comment further at this time. (more…)
Adam V. Russo | May 24, 2010
MyHealthGuide Source: Todd Leeuwenburgh, Editor, The Guide to Self-Insuring Health Benefits newsletter, Employer Health Benefits, Thompson Publishing Group, 5/20/2010, www.Thompson.com
Employers have a set of immediate action items to comply with newly promulgated federal health reform laws. How employers implement those changes will determine whether health coverage costs remain steady after health reform exigencies are met. (more…)
Adam V. Russo | May 24, 2010
MyHealthGuide Source: Fred Hunt, President, Society of Professional Benefit Administrators (SPBA), 5/21/2010, www.SPBATPA.org
Background
I have been giving these industry and market report/forecasts for 30 years. Most have predicted things that seemed unbelievable at the time. However, the accuracy rate of coming true has been over 90%. This is being written when the shock of the Obama health reform bill has not worn off, and we are only at the start of about a dozen more years of regulatory decisions and implementation. However, that uncertainty does not impact my forecasts here. (more…)
Adam V. Russo | May 24, 2010
On April 21, 2010, in the case of Conkright v. Frommert, 559 U.S. ___ (2010), the United States Supreme Court held that where a plan administrator is granted deference in exercising its discretionary authority, and the administrator subsequently issued an incorrect interpretation related to the plan document, absent malice, the plan administrator is not disqualified from making future interpretations of the plan on the same or related matters. (more…)
Adam V. Russo | May 24, 2010
MyHealthGuide Source: HCC Life Insurance Company (HCC Life), 5/17/2010, www.hcclife.com
ATLANTA — HCC Life Insurance Company (HCC Life), a leading carrier of medical stop loss insurance, announced its plans to incorporate the new requirements from recent healthcare reform into its policy prior to the required timeline. (more…)
Adam V. Russo | May 24, 2010
MyHealthGuide Source: FreeERISA, 5/20/2010,
FreeERISA announces that their Form 5500 database has been updated with the most recent release of data from the Department of Labor adding more than 128,000 new 2008 form 5500s to the database. (more…)
Adam V. Russo | May 21, 2010
By TODD ACKERMAN HOUSTON CHRONICLE
Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.
Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year. (more…)
Adam V. Russo | May 21, 2010
by Emily Ramshaw
Prudie Orr is a licensed psychiatric nurse practitioner, but these days she feels more like an aspiring indentured servant. Since moving to the Central Texas town of Georgetown in December, she’s been unable to open a practice and see patients — because she can’t find a doctor who will allow it. “I’ve gone up and down the telephone book, calling every psychiatrist in town,” she says. “I have to go hat in hand to these folks to see if they will grant me the privilege of making a living.” (more…)
Adam V. Russo | May 21, 2010
In most cases, the children of a health plan’s enrollees must be offered coverage until age 26.
By Francesca Lunzer Kritz
Special to the Los Angeles Times
Ed Emmerman’s a happy guy, and not just because he’ll be able to stop paying college tuition for his older daughter, Sarah, 21, when she graduates with a bachelor’s degree from the University of Vermont later this month. He’s also pleased that Sarah will be insured for the foreseeable future. (more…)
