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General Business Insurance Health

Read need-to-know updates, commentary, and analysis on General Business issues written by leading professionals.

Seventh Circuit OKs Exclusive Network Agreements Between “Must-Have” Hospital and Health Insurers

by Mintz Levin on

In an opinion written by Judge Posner, the Seventh Circuit on Friday gave its stamp of approval to a “must-have” hospital’s bargaining to exclude competitors from certain narrow-network payor contracts in and around Peoria,...more

US: Governor Cuomo and NY Department of Financial Services Respond to Congressional Efforts to Repeal the Affordable Care Act with...

by Hogan Lovells on

On 5 June 2017, in response to the Congressional efforts to “repeal and replace” the Affordable Care Act (the ACA), the New York Department of Financial Services (NYDFS) issued a press release entitled “Governor Cuomo...more

Out-of-Network Physician’s Claim Against Insurer Not Preempted by ERISA

The Second Circuit concluded that a promissory estoppel claim by an out-of-network provider against an insurer was not completely preempted by ERISA and thus remanded the claim to state court for further proceedings. The...more

Fifth Circuit’s Pierre Deference In ERISA Cases Trumps Texas’s Anti-Discretionary Language Statute

by DeWitt Law, LLC on

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, 2017 U.S. App. LEXIS 7072(5th Cir. Apr. 21, 2017), which involved a claim for benefits under an ERISA-governed health policy, the Fifth Circuit held that...more

Can Purchasing Efficiencies Save Mega-Mergers? The D.C. Circuit Says “No”

by Proskauer Rose LLP on

Efficiencies, economies of scale, and the general desire to improve the customer experience are the lifeblood of all mergers. And one of the most common efficiencies in any deal comes from enhanced purchasing power, or the...more

Bill to Eliminate Health Insurers' Antitrust Exemption Passes in the House

by Baker Ober Health Law on

On March 22, the House of Representatives passed H.R. 372, the "Competitive Health Insurance Reform Act of 2017," by a vote of 416-7. The legislation would repeal the antitrust exemption that the health insurance industry...more

Sixth Circuit Issues Trilogy on Retiree Health Benefits

In three decisions issued on the same day, the Sixth Circuit held that Meritor retirees were not entitled to lifetime health benefits, while retirees at Kelsey-Hayes and CNH Industries were entitled to contractually vested...more

Supreme Court says lawyer's referral of client to a doctor for treatment is attorney-client privileged communication, and out of...

The Florida Supreme Court declared that the attorney-client privilege shielded a motor vehicle accident plaintiff from being required to disclose that her attorney had referred her to a doctor for treatment. In Worley v....more

News from Second and State

Weekly Wrap - Only the House of Representatives were in session this week, but it was a pretty busy week nonetheless. Topics from the budget to mandatory minimum sentences were all up for review and debate. The...more

New Medicare Conditional Payment Case: Federal Court Requires CMS To Perform Surgery On Its Primary Plan Reimbursement Demands

Doctors often treat Medicare beneficiaries for accident related injuries (for which a “primary” auto or workers’ compensation carrier must reimburse Medicare) and unrelated maladies at the same visit. Billing for the visit...more

Insurance Claims Report Spotlights Risks To Assisted Living Facility Operators

Late last year CNA, one of the nation’s largest commercial insurance companies, issued a report summarizing professional liability insurance claims for senior living facilities that it closed between 2011 and 2015. Although...more

Trump administration issues proposed health insurance market stabilization rule: Will it be enough to stabilize exchange...

by Hogan Lovells on

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

Who Cares for Your Aging Family When You Can’t? (Hint: Not Robots)

Subscribe to the show in iTunes here: http://itunes.apple.com/us/podcast/who-cares-for-your-aging-family/id1081120870?i=1000380982871&mt=2 Like most people, I didn’t want to think about my parents getting old, getting...more

Is there operating room for compulsory PI insurance

by Hogan Lovells on

Since its inception on 30 August 2010, the regulations requiring health professionals to have professional indemnity insurance have lain dormant in a state of moratorium, almost as a distant memory some do not wish to recall....more

Peerless, This is Not: Sixth Circuit Finds No Latent Ambiguity in Consent to Settle Requirement in Excess Policy

by Carlton Fields on

Disputes between policyholders and excess insurers often involve events that occurred before the underlying defense costs or indemnity payments reached the excess layer. In Stryker Corp. v. Nat’l Union Fire Ins. Co. of...more

President-elect Trump's potential priorities for insurance regulation

by Dentons on

Apart from a fundamental disagreement between the parties as to whether the Affordable Care Act ("ACA") should be repealed and replaced, insurance regulatory issues did not play a large role in the Presidential campaign. That...more

Recent CyberSecurity Incidents Emphasize Importance of Cyberinsurance

by Akerman LLP - Health Law Rx on

As the threat of cyberattacks continues to pose daily threats to businesses large and small, more companies have turned to cyber insurance products to shore up protection against these disruptive threats. A spate of recent...more

NAIC Long-Term Care Innovation Subgroup Public Hearing

by Carlton Fields on

At the NAIC Summer 2016 National Meeting, the Long-Term Care Innovation (B) Subgroup held a public hearing as part of an initiative to address the challenges facing the private LTC market. With baby boomers retiring at a rate...more

Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

by Snell & Wilmer on

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims. The letters are usually 20 to 30 pages long, not very specific, and...more

Big Summary Judgment Win for Hospital Defending $300M Exclusive Dealing Antitrust Suit

by Mintz Levin on

After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more

Cybersecurity Awareness Month: Visits From the Ghosts of Claims Past and Claims Future

by Carlton Fields on

Cybersecurity awareness month is nigh upon us again, and thus perspective is in order. 2016 brought us the first collection and analysis of the nascent claims history of the burgeoning cyber-insurance market. On August 27,...more

Under the Dome: Inside the Maine State House

by Pierce Atwood LLP on

Under the Dome: Inside the Maine State House provides a high-level overview of recent activity at the Maine State House. Community Health Options to Focus on Maine by Leaving New Hampshire In 2017, New Hampshire...more

Eleventh Circuit Finds Mere Existence Of Insurance Contract Satisfies Condition Precedent To Action For Double Damages Under The...

The Eleventh Circuit Court of Appeals recently held that a private insurance company/PART C Medicare Advantage Organization (MAO) may sue a Personal Injury Protection (PIP) insurance carrier for reimbursement of medical...more

Compounding Pharmacy’s Group Boycott Claim Survives Motion to Dismiss

On August 23, 2016, the District Court for the Eastern District of Missouri allowed claims by a compounding pharmacy to proceed, denying a motion to dismiss filed by the defendant pharmacy benefit manager (“PBM”). In...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

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Cybersecurity

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