Archive for the ‘News’ Category

Business groups won a partial victory when Gov. Deval Patrick’s administration decided to exempt companies with 50 or fewer full-time employees from a new health care coverage requirement.  The Patrick administration unveiled the change, which would collectively cost businesses in the state about $30 million a year under the state’s “Employer Fair Share” rules. Read more

Elizabeth Edwards, the wife of former Democratic presidential candidate and former Sen. John Edwards linked the current economic downturn with problems in the U.S. health care system, the AP/Kansas City Star reports. Elizabeth Edwards, who has incurable cancer, has made several recent public appearances in support of efforts to expand health insurance to all residents. Read more

Download the entire 2008 Health Care Cost Survey

Many families are paying higher out-of-pocket expenses for both health insurance premiums and health care services.  As a result, paying for medical care has become more difficult than ever, likely leading many families to make difficult financial trade-offs and increasingly forgo needed medical care. Read more

Americans are seeing unusual options in their health provider networks, such as doctors and hospitals in Singapore, Costa Rica and other foreign destinations.  In an effort to control rising costs, a growing number of insurers and employers are giving people the choice to seek treatment in other countries, a practice known as medical tourism. Until recently, most Americans who traveled abroad for medical care were uninsured, or were seeking procedures not covered by insurance, such as cosmetic dentistry or aesthetic surgery. Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures. Read more

While health care costs increases continue to far outpace inflation, costs are rising at a far more moderate pace than a few years ago, according to two surveys released last week.

The surveys-one by the Washington-based Kaiser Family Foundation and Chicago-based Health Research & Educational Trust, and the other by Stamford, Conn.-based benefit consultant Towers Perrin-also show that employers are turning more to consumer-driven health plans to help control costs. Read more

In line with trends in the private sector, health insurance premiums will increase an average of 7% next year in the health insurance program covering federal employees and retirees, the Federal Office of Personal Management said last week.

The 7% increase for the Federal Employee Health Benefits Program-which is the nation’s largest group plan, covering about 8 million people, is similar to rate increase industry experts expect private-sector employers to be hit with next year. Read more

On September 22, 2008 the Fifth Circuit issued its decision in Young v. Wal-Mart Stores, Inc., et. al.

The case involved an ERISA claim for accidental death and dismemberment (AD&D) benefits in the amount of $25,000. The decedent suffered from a history of severe hypertension. He stopped taking his medication, became very ill and began vomiting profusely and choked to death. The policy provided an exclusion for losses related “in whole or in part from…sickness.” Read more

Cost increases still remain much lower than those of a few years ago.  In 2008, group health care costs increased by an average of 6.0%, to $8,331 per employee, and are projected to rise next year by 6.4%, according to Hewitt Associates, Inc. The analysis is based on information from more than 400 employers.

This year’s 6.0% average increase is up from a 5.3% increase in 2007 but is substantially lower than 2006’s average increase of 7.9% and the 9.2% hike in 2005. Read more

Please review the attached documents regarding a class action suit for which settlement has been proposed.  It addresses patients who were prescribed Paxil prior to their eighteenth birthday, for which you may have paid claims and may be due reimbursement.

Please review the information we have provided and determine if this affects you. 

The Providence Journal features a review by Mandy Twaddell, analyzing the new book by Peter Gosselin.  The book’s title is High Wire: The Precarious Financial Lives of American Families.  The book describes various pitfalls many American families experience today, and tells the tale of at least one encounter with ERISA. Read more

A vast difference between the two Presidential candidates is the role of the U.S. government providing health insurance coverage.

Senator Obama promotes a national policy that supports individuals and small employers.  Obama would rely much more on government mandates in which income based federal funding would be provided to help assure expansion on coverage.  In this plan, employers would have to either provide health insurance coverage to its employees or pay into a national plan that would be available to individuals not covered by employee plans.  Regardless of which direction would choose, they would also benefit from a new federal health reinsurance program in which the government would take on liability for catastrophic loss in health care claims. Read more

Following on the heels of our previous post, CNN Anderson Cooper posted an update advising that Wal-Mart has decided to waive its right to recover the funds in controversy. 

http://ac360.blogs.cnn.com/2008/04/01/wal-mart-tells-brain-damaged-woman-keep-the-money/

While reducing or waiving a lien on a case by case basis is certainly not unusual, doing so now that this case has attracted so much attention may hurt Plan rights to subrogation in future cases.  Hopefully, this will not set an unofficial precedent whereby every patient with a sad story publicly contests the Plan’s rights to reimbursement.  If it does, the costs of providing employee benefit plans will surely skyrocket.  In the end, it is the employees who pay for “double dipping” when their contributions need to increase, or the Plan is dissolved.

By Ron E. Peck, Esq. and Adam V. Russo, Esq.

As many of you have no doubt seen, The Wall Street Journal published the story of Deborah Shank and her employer, Wal-Mart, some months ago.  In a nutshell, Ms. Shank was severely injured in a car wreck.  Her substantial medical expenses were paid for by the Wal-Mart self-funded benefit plan.  In the meantime, Ms. Shank’s family sued the insurance carrier of the truck that collided with her.  They settled their claim for $700K of the $1 million policy limit.  Part of their claim was for medical expenses; (expenses they sought to collect, but were paid for by the Wal-Mart plan).  Wal-Mart heard about the settlement, which included monies for the medical expenses, they - not the Shanks - had paid, and sought to enforce their Plan Document’s subrogation / reimbursement provision.   Read more

SIIA Members Discuss Increases in Employee Health Care Costs Since 1999.

San Francisco Restaurant Goers Pay for the City’s New Health Care Law.

Massachusetts Health Care Program Getting More Expensive.

Read More.