Health Insurance

News & Analysis as of

Health Care: Out-of-Network Provider Coverage, Notice, Disclosure, and Dispute Resolution (3/15)

New York State has adopted legislation to address consumer complaints related to health insurance coverage and "surprise bills" for health care services performed by out-of-network physicians and providers....more

New York – Emergency Medical Services and Surprise

The Emergency Medical Services and Surprise Bills Law (the "New Law"), which goes into effect March 31, 2015, increases protection of New York consumers from "surprise bills" received for medical services performed by certain...more

Multiple class action lawsuits filed against Premera Blue Cross for data breach

Days following Premera Blue Cross’s public announcement that it had experienced a data breach affecting approximately 11 million, it has been sued five times (as of the time of this writing) in proposed class action lawsuits...more

OIG Warns Lab “Pull-Through” Arrangements May Be Illegal

In an important advisory opinion, the U.S. Department of Health and Human Services Office of Inspector General (OIG) gave a thumbs-down to a proposed clinical laboratory “pull-through” arrangement even though the patients in...more

Is Your Company Ready to Comply with Encryption of Individually Identifiable Health Information?

New Jersey’s new data privacy standard, signed into law as S. 562 by Gov. Chris Christie on January 9, requires health insurance carriers that are authorized to issue health benefit plans in New Jersey to protect individually...more

Another Health Plan Hit By Massive CyberAttack and Class Actions Follow

Coming fresh off the heels of the Anthem data breach Premera Blue Cross announced on March 17th that it was the victim of a “sophisticated” cyberattack that may have exposed the personal information of approximately 11...more

Hospital Wins First Round Against Largest Rival in Antitrust Suit Alleging Illegal Exclusive Dealing Agreements with Insurers

The waves of change affecting health care providers include reimbursement and funding developments, the impact of the Affordable Care Act, technological and medical advances, provider network design transformations imposed by...more

US Supreme Court to Consider ERISA’s Tracing Requirements

On March 30, the U.S. Supreme Court announced it would review Bd. of Trustees of Nat. Elevator Indus. Health Ben. Plan v. Montanile, 593 F. App’x 903 (11th Cir. 2014)....more

Blog: HIPAA FAQ Series: Does HIPAA Permit Communications via E-mail with PHI Subjects?

Last week, we introduced a new series to this blog that will cover frequently asked questions regarding the Health Insurance Portability and Accountability Act (HIPAA). This week, the series continues by delving into a hot...more

Colorado Passes “Full Parity” Telemedicine Law, Although Some Gaps Remain

On March 20, 2015, Colorado Governor John Hickenlooper signed into law HB 15-1029, which requires that insurers operating in Colorado reimburse health care providers for telehealth services in all of Colorado’s counties,...more

HIPAA Breach Affects Many Western New York School Districts

Recently, a national BlueCross BlueShield affiliate, Anthem, Inc., discovered that its information technology systems was hacked. The information believed to have been accessed includes names, member ID numbers, dates of...more

The ERISA Litigation Newsletter - March 2015

Editor's Overview - This month's newsletter discusses how to avoid liability under ERISA through plan design, including statute of limitations provisions, venue provisions, and anti-assignment provisions. Courts have...more

Federal Court Allows Hospital’s Antitrust Claims to Proceed on Narrow Market Definition

Winning an antitrust lawsuit hinges on defining the “relevant market,” and this case may prove the point. Methodist Health Services Corporation notched the first win in its battle against Saint Francis Medical Center as a...more

Obama Administration Finalizes Health Insurance Wraparound Coverage Rule

The Departments of Labor, Health and Human Services, and Treasury published a final rule on March 18, 2015 that amends the definition of excepted benefits to allow group health plan sponsors, in limited circumstances, to...more

The ACA Five Years Later: A Good Investment or Risky Business? We Dare Not Opine!

The enactment of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, represents a significant legislative milestone in healthcare reform and a continuing communications challenge for...more

BEST IN LAW: Employers need to heed Obamacare Reporting Rules

Compliance with reporting obligations is always important for any employer, but the employer reporting requirements under the Affordable Care Act pack a significant penalty that makes compliance particularly...more

Health Update - March 2015

Supporting Informed Decision Making in the Health Insurance Marketplace: A Progress Report - Editor’s note: As Affordable Care Act (ACA) implementation moves forward and the marketplace continues to evolve, there is a...more

Can Retirees Use HSAs?

Yes – and no. A Health Savings Account (HSA) is like an IRA but for the payment of medical expenses instead of retirement income. HSA contributions are not taxed, and like IRA accounts, they belong to the employee. ...more

Washington Healthcare Update

This Week: Bipartisan, Bicameral Permanent SGR Fix Introduced... House Budget Committee Advances FY2016 Budget Proposal... National Coverage Determinations Proposed for Removal... HHS Releases Proposed Rules on EHR Incentive...more

"Surprise Medical Bills" Law

Consider the following scenario. You are a patient who had a colonoscopy performed by a physician who participates in your health insurance plan. A week later, you receive two “surprise” medical bills from an anesthesiologist...more

Health Alert (Australia) - March 23, 2015

In This Issue: Judgments; Legislation; and Reports. Excerpt from Reports: New South Wales (NSW). Ministry of Health - Media Releases - 18 March 2015 - NSW says protect against mosquitoes after huge...more

Week in Review - March 2015 #3

Friday marked the first committee deadline and thus a flurry of activity at the Capitol to act favorably on bills in their respective policy committees. MNsure - When Governor Mark Dayton’s supplemental budget...more

To Understand King v. Burwell Look To Yates v. US

On March 4, 2015, the U.S. Supreme Court heard argument in King v. Burwell, the most publicized case to reach the high court in some time. The issue is whether certain tax subsidies essential to the proper fiscal management...more

California Court Rejects Insurer’s Right to Rescind Policy

In DuBeck v. California Physicians’ Service, 2015 Cal. App. LEXIS 203 (March 5, 2015, opinion filed), the California Court of Appeal examined whether a health insurer’s conduct constituted a waiver of the right to rescind its...more

More Risk for All and “Free” Care?

While the Supreme Court continues to debate the outcome of King v. Burwell in their chambers, stakeholders must be prepared for the potential fallout the nine justices’ ruling may have. Two weeks ago, we summarized the...more

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