Mealeys

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Mealey's ACA - Autism Therapy Coverage Class Seeks Preliminary Approval Of Settlement
Posted on 8 Nov 2019 by Mealeys

SEATTLE - Catholic health plan defendants will cover autism behavior therapy without exclusion or limitation and create an $800,000 fund reimbursing class members for out-of-pocket expenses under the terms of a settlement for which plaintiffs sought preliminary... Read More

Mealey's ACA - Dialysis Provider Portrays Assignment As Broad In ERISA, Medicare Claims Suit
Posted on 28 Oct 2019 by Mealeys

SAN FRANCISCO - A health care plan violated the Employee Retirement Income Security Act when it failed to notify insureds that the plan no longer offered in-network dialysis providers, a move that violated Medicare rules when prohibiting discrimination... Read More

Mealey's ACA - Government, Amicus Say ACA Never Mandated Risk-Corridor Payments
Posted on 28 Oct 2019 by Mealeys

WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA) never appropriated funds for the risk corridor, and congressional action later limited how the program would function, dooming insurers' suit seeking billions of dollars from... Read More

Mealey's ACA - 11th Circuit Affirms Judgment In ERISA Spine Surgery Benefit Case
Posted on 25 Oct 2019 by Mealeys

ATLANTA - An insurer with discretionary authority did not err when it denied coverage for two-level spinal fusion surgery under the plan's exclusion on experimental procedures, an 11th Circuit U.S. Court of Appeals panel held Oct. 24 in rejecting... Read More

Mealey's ACA - High Court Will Not Review Ruling Denying Woman's Appearance At Hearing
Posted on 21 Oct 2019 by Mealeys

WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 21 denied a woman's petition for a writ of certiorari seeking review of a Kentucky Supreme Court's ruling that she could not appear at a hearing challenging her managed care organization (MCO)... Read More

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 - 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 - 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 - 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 - 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 - 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

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 - 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