The Women's Health and Cancer Rights Act (WHCRA), passed by Congress in 1998 and adopted as part of the Employee Retirement Income Security Act (ERISA), was enacted to protect women from abuses related to health plan coverage for a mastectomy and … [Read more...] about Breast Reconstruction and the Women’s Health and Cancer Rights Act (WHCRA)
The Departments of Health & Human Services (HHS), Labor, and the Treasury together with the Office of Personnel Management (OPM) issued, on September 10, 2021, a second set of regulations under the No Surprises Act (NSA). The proposed rule … [Read more...] about Enforcement Provision of the No Surprises Act (NSA) Proposed Rule Issued
At face value, it seems logical that insurance companies are responsible for paying health benefit claims. But are they? Determining the entity responsible for paying claims requires an understanding of how health benefit plans are structured and … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part IV: Know Who Is Paying Your Claim?
The No Surprises Act (NSA) becomes effective on January 1, 2022 and will apply to virtually all commercial medical claims covered by ERISA, Non-ERISA, self-insured and fully insured plans for (1) emergency care performed by an out-of-network … [Read more...] about Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
On July 1, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury issued part I of the regulations in connection with federal No Surprises Act that protects patients from surprise medical … [Read more...] about No Surprises Act Regulations Part I Released
Our client, an out-of-network orthopedics practice group, filed a lawsuit against Blue Cross Blue Shield of Alabama (BCBSAL) to dispute the medical reimbursement for a spinal surgery performed on July 12, 2016. The patient in the suit had coverage … [Read more...] about Court Denies BCBSAL Motion to Dismiss Based on Anti-Assignment Clause in Medical Reimbursement Dispute Finding Derivative Standing Exists Under ERISA
We are pleased to share news of a class-action lawsuit filed against United Healthcare (UHC), in a New Jersey federal court, concerning its ongoing denial of reimbursement for co-surgeons (CO) and assistant surgeons (AS) when performing a DIEP Flap … [Read more...] about Class Action Suit Filed Against UHC for Denied Breast Reconstruction Medical Claims
In a recent decision by the District Court of New Jersey between our client, an out-of-network New Jersey based medical practice and Aetna regarding services related primarily to emergency care, the Court granted our client’s motion to remand the … [Read more...] about District Court of New Jersey Remands Case to State Court Declaring ERISA Preemption Does Not Apply
True Market Value® is pricing tool developed by the car industry (Edmunds) to help consumers navigate the complicated process of negotiating a fair price for a new or used car. This concept can be adapted by out-of-network providers to calculate the … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part III: How to Decode the True Maximum Value of a Medical Claim
Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he … [Read more...] about Will the No Surprises Act be Implemented as Lawmakers Intended?