Recent Posts

Mealey's ACA - United, Class Brief Reconsideration In Facility-Fee Class Case
Posted on 15 Oct 2019 by Mealeys

NEW YORK - Whether assignment of Employee Retirement Income Security Act rights requires reversing class certification of a group of surgery providers claiming that the insurer denied payment for facility fees without regard for whether coverage existed... Read More

Mealey's ACA - U.S. High Court Considers Petition Challenging Kentucky Medicaid Hearing Denial
Posted on 15 Oct 2019 by Mealeys

WASHINGTON, D.C. - If a state court may simply deny a federally mandated right to a Medicaid hearing, it is in reality no right at all, a woman argues in a reply brief as the U.S. Supreme Court justices prepare to convene and consider her petition for... Read More

Mealey's ACA - 5th Circuit Doesn't Want Second Look At Dialysis Provider's Suit
Posted on 14 Oct 2019 by Mealeys

NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals denied a motion for rehearing Oct. 10, letting stand a decision finding a health care plan's anti-assignment provision prevented a health care provider from suing an insurer (Dialysis Newco Inc... Read More

Mealey's ACA - Limited Partnership Action Seeks Labor Department Opinion On Health Care Plan Status
Posted on 9 Oct 2019 by Mealeys

DALLAS - A limited partnership filed suit in Texas federal court on Oct. 4, seeking to force the U.S. Department of Labor (DOL) to issue an advisory opinion declaring that the self-insured health plan it offers common-law employees and limited partners... Read More

Mealey's ACA - HHS Barred Under Colorado Law From Offsetting Insolvent Insurer's Debt, Court Says
Posted on 7 Oct 2019 by Mealeys

WASHINGTON, D.C. - Colorado insurance liquidation law precludes the U.S. Department of Health and Human Services (HHS) from using money owed to an insolvent Colorado insurer to pay debts owed under the Patient Protection and Affordable Care Act's... Read More

Mealey's ACA - Top Court Denies Review In ERISA Health Care Rights-Assignment Spat
Posted on 7 Oct 2019 by Mealeys

WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 7 denied a health care insurer's petition for review, leaving stand a Fifth Circuit U.S. Court of Appeals ruling finding that direct payments to a provider waived an Employee Retirement Income Security... Read More

Mealey's ACA - Plaintiffs Have Standing, But Not Support For Parity Act Case, Judge Says
Posted on 1 Oct 2019 by Mealeys

SALT LAKE CITY - A man who claims that he spent $340,000 on his daughter's mental health treatments after an insurer improperly denied coverage has standing but has not adequately alleged a violation of the Mental Health Parity and Addiction Equity... Read More

Mealey's ACA - Provider Seeks Rehearing After Panel Rules On Assignment, ERISA Preemption
Posted on 30 Sep 2019 by Mealeys

NEW ORLEANS - A dialysis provider Sept. 25 asked the Fifth Circuit U.S. Court of Appeals to review a panel ruling finding a health care plan precluded assignment of Employee Retirement Income Security Act rights and that the statute preempted Tennessee... Read More

Mealey's ACA - United Wants Judge To Reconsider Facility-Fee Coverage Class Ruling
Posted on 26 Sep 2019 by Mealeys

NEW YORK - Determining whether a class of surgery providers properly obtained an assignment of rights under Employee Retirement Income Security Act plans requires claim-by-claim analysis precluding certification, an insurer tells a New York judge in a... Read More

Mealey's ACA - Judge Says Attorney Fees Warranted In Health Care Spat, But Wants More Evidence
Posted on 25 Sep 2019 by Mealeys

TRENTON, N.J. - A man's "completely unsubstantiated" allegations seeking usual and customary medical expenses for which his plan clearly does cover warrant an award of attorney fees, but the plan sponsor must submit more evidence demonstrating... Read More

Mealey's ACA - Dialysis Provider's Suit Fails On Statutory, Standing Grounds, Judge Says
Posted on 25 Sep 2019 by Mealeys

CINCINNATI - A health insurance administrator's decision to make all dialysis companies out-of-network providers does not violate the Medicare Secondary Payor Act (MSPA), and the provider's assignment is limited to insurance benefits and does... Read More

Mealey's ACA - Couple's ERISA Case For Inpatient Treatment Largely Rejected By Judge
Posted on 24 Sep 2019 by Mealeys

NEW ORLEANS - A federal judge in Louisiana largely rejected a couple's Employee Retirement Income Act claims in Sept. 19 and 24 rulings and found that the law's conflict preemption statute doomed the state law claims (Soileau & Associates... Read More

Mealey's ACA - Pay Rate Allegations Keep Health Insurance Contract Claims Alive, Judge Says
Posted on 20 Sep 2019 by Mealeys

SAN JOSE, Calif. - A medical provider's allegation that an insurer confirmed a 70 percent reimbursement rate supports breach of contract claims because it goes beyond simple coverage verification, a federal judge in California held Sept. 17 (California... Read More

Mealey's ACA - Cardiovascular Specialists' Contract Claim Sole Survivor Of Motion To Dismiss
Posted on 20 Sep 2019 by Mealeys

NEW YORK - Allegations that health care providers treated individuals in government and church plans outside the reach of the Employee Retirement Income Security Act precludes preemption, and while the breach of contract claim survives, the remaining... Read More

Mealey's ACA - Insurer Says Standing, Merits Don't Require Review Of Medicaid Hearing Challenge
Posted on 20 Sep 2019 by Mealeys

WASHINGTON, D.C. - The U.S. Supreme Court lacks jurisdiction over a Kentucky top court ruling on standing, and nothing in a ruling precluding a hearing after an insurer denied coverage under Medicaid would warrant review, the insurer tells the court in... Read More