cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
In a surprising decision, the 3rd U.S. Circuit Court of Appeals used the concept of “appropriate equitable relief” to restrict an employer-sponsored health plan’s recovery from a third-party settlement. Full reimbursement of what the plan paid out would have been “inappropriate and inequitable,” even though the plan had asserted recovery rights over any monies collected from a third party. Full recovery would have been unfair because: (1) the plan participant’s recovery ended up being less than what the plan paid after attorney’s fees were deducted; and (2) the plan never intervened in the third-party recovery. The outcome diverges from many recent cases, which upheld plans’ claims on total proceeds, regardless of whether the plan participant was “made whole” or had money to pay attorney’s fees. (more…)
Category: 3rd, Common Fund, ERISA, Pennsylvania, Reimbursement, Subrogation, Third Party Agreements |
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Adam V. Russo | November 22, 2010
MyHealthGuide, www.myhealthguide.com
MyHealthGuide Source: Adam V. Russo, Esq., Co-founder, CEO of The Phia Group LLC, and contributing editor for Thompson Publishing Group’s the Employer’s Guide to Self-insuring Health Benefits, Todd Leeuwenburgh, Editor.
When visiting London, there are many fascinating sights to visit. You may choose to spend some time strolling around Piccadilly Circus, visiting some of the local pubs, or seeing historic Westminster Abbey or Big Ben. Regardless, one of the fastest and easiest ways to get from point A to point B is via the London Underground, or if you’re a local, the Tube. The Tube is London’s subway system, and if you’ve ever had the pleasure of using it, you’ll remember one thing above all else: “Mind the Gap!” In England, they want you to avoid the space between the boarding platform and the train. (more…)
Category: Plan Language, Summary Plan Description, Third Party Agreements |
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Adam V. Russo | October 6, 2010
Tomorrow I will be speaking at SPBA’s Fall 2010 Meeting in Phoenix, AZ.
Click here to see a sneak peak of my presentation “How to Avoid PPO Landmines”
Category: Plan Language, Provider Reimbursement, Third Party Agreements |
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Adam V. Russo | April 20, 2010
Introduction
Over the course of the past several years, the value proposition of Preferred Provider Organizations (PPOs) has come under increasing scrutiny. Many have thought that if price can be controlled, health care costs can be controlled or at least mitigated. The truth is that health care costs are an intricate and complex balancing act between price and utilization (here simply defined as the number of units consumed). Attempts to control one have always resulted in equal and opposite reactions in the other. PPOs perform a necessary service for the industry, but their clout seems to be fading and with it, their value proposition has been called into question. (more…)
Category: Fiduciary Liability, Provider Reimbursement, Third Party Agreements |
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