Mealeys

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Mealey's ACA - Judge: Allegations Support Mental Health Coverage Disparity Case
Posted on 18 Sep 2019 by Mealeys

SALT LAKE CITY - There is no evidence that plaintiffs seeking to recover Employee Retirement Income Security Act benefits for mental health treatments are part of other class actions, and they successfully allege disparate treatment, a federal judge held... Read More

Mealey's ACA - Amici Say 5th Circuit Ruling Contravenes Precedent, ERISA
Posted on 17 Sep 2019 by Mealeys

WASHINGTON, D.C. - Direct payments to health care providers do not waive anti-assignment provisions or transform the provider into the type of party that can sue an insurer under the Employee Retirement Income Security Act, industry groups tell the U... Read More

Mealey's ACA - United Facility-Fee Coverage Case Granted Class Status
Posted on 16 Sep 2019 by Mealeys

NEW YORK - Allegations that an insurer improperly denied coverage for out-of-network facility fees for certain providers support certification of a class seeking declaratory and injunctive relief, but not classwide benefit awards, a federal judge in New... Read More

Mealey's ACA - Out-Of-Network Health Care Provider Sees Texas Suit Reinstated
Posted on 13 Sep 2019 by Mealeys

CORPUS CHRISTI, Texas - An out-of-network health care provider may proceed to trial on claims that an insurer did not reimburse it at the appropriate rate and has standing as the assignee of the plan beneficiaries, a Texas appeals court held Sept. 12... Read More

Mealey's ACA - Judge Finds Allegations Can't Support State Law Claims By Surgery Provider
Posted on 13 Sep 2019 by Mealeys

WEST PALM BEACH, Fla. - A spinal surgery provider's allegations that it continues to serve an insurer's customers provides a basis for a declaratory relief action, but its state law claims fail as it is not a party to the contract and did not... Read More

Mealey's ACA - Appeals Court: Plan Bars Rights Assignment; ERISA Preempts Tennessee Health Law
Posted on 13 Sep 2019 by Mealeys

NEW ORLEANS - A district court erred in finding ambiguous an anti-assignment provision in an Employee Retirement Income Security Act plan and that Tennessee law making insurers liable to third-party providers necessarily implicates the plan and is preempted... Read More

Mealey's ACA - Judge Adopts Report Finding Health Plan Remedy Exhaustion Claims Conclusory
Posted on 5 Sep 2019 by Mealeys

FORT LAUDERDALE, Fla. - A federal judge in Florida on Sept. 5 rejected a health care provider's objections and affirmed a report and recommendation in which a magistrate judge concluded that the plaintiff had not adequately demonstrated exhaustion... Read More

Mealey's ACA - Insurers Say Congress Never Repealed Risk Corridor, Still Owes Billions Under ACA
Posted on 3 Sep 2019 by Mealeys

WASHINGTON, D.C. - Appropriations riders simply limited Patient Protection and Affordable Care Act (ACA) risk-corridor funding and cannot be read as repealing payments obligations under the program, five insurers told the U.S. Supreme Court on Aug. 30... Read More

Mealey's ACA - Orthopedic Provider, Aetna Square Off Over $335,000 In Unpaid Bills
Posted on 21 Aug 2019 by Mealeys

TRENTON, N.J. - A health insurer ask a federal judge in New Jersey to dismiss an orthopedic medical provider's "kitchen-sink approach" to allegations in a July 17 memo, but the provider says in an Aug. 20 opposition that Aetna relies on... Read More

Mealey's ACA - Judge: Lack Of Plan Documents Dooms Expanded Health Care Coverage Class
Posted on 21 Aug 2019 by Mealeys

TRENTON, N.J. - A proposed class of self-insured health plans in which Aetna Life Insurance Co. allegedly imposes undisclosed internal standards for coverage would require access to plan documents the plaintiffs have not submitted, a federal judge in... Read More

Mealey's ACA - Couple Wants 10th Circuit To Hear Case Alleging Health Care Discrimination
Posted on 20 Aug 2019 by Mealeys

SALT LAKE CITY - A Utah federal judge on Aug. 13 granted summary judgment to an interpreter service accused of discrimination under the Patient Protection and Affordable Care Act (ACA) and other laws. The couple filed a notice on Aug. 18 that they intended... Read More

Mealey's ACA - Judge: Conclusory Claims Doom ERISA, State Law Health Insurance Case
Posted on 16 Aug 2019 by Mealeys

FORT LAUDERDALE, Fla. - Failure to exhaust administrative remedies provides an absolute bar to Employee Retirement Income Security Act claims, and there is no evidence that the provider's services conferred a benefit on the insurer, dooming the remainder... Read More

Mealey's ACA - Florida Court Won't Revive Out-Of-Network Coverage Case
Posted on 14 Aug 2019 by Mealeys

JACKSONVILLE, Fla. - Collateral estoppel prevents a woman from pursuing breach of contract claims in a health insurance coverage case, and conduct regulated by the office of insurance is exempt from the state's unfair competition law, a Florida appeals... Read More

Mealey's ACA - Aetna Asks Court For Sanction Over Health Care Providers' Unresponsiveness
Posted on 14 Aug 2019 by Mealeys

LOS ANGELES - Aetna Life Insurance Co. asked a federal judge in California on Aug. 13 for dismissal of what remains of an Employee Retirement Income Security Act case as a sanction for health care providers' failure to comply with a court deadline... Read More

Mealey's Toxic Tort/Environmental - Women: Insurer Can't Create Barriers To ACA-Mandated Lactation Services
Posted on 12 Aug 2019 by Mealeys

ST. LOUIS - The Patient Protection and Affordable Care Act (ACA) cannot simultaneously require coverage for lactation services while permitting insurers to place administrative barriers that make obtaining that care impossible, two women tell the Eighth... Read More