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Health Care Providers Denial of Insurance Coverage

Arnall Golden Gregory LLP

AGG Talks: Healthcare Insights Podcast - Episode 4: What to Do When Insurance Companies Deny Behavioral Health Claims

In this episode, AGG Healthcare Litigation co-chair Jason Bring is joined by AGG Healthcare Litigation partners Rich Collins and Damon Eisenbrey to discuss what you can do when insurance companies deny behavioral health...more

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

McDermott Will & Emery

CMS Interoperability and Prior Authorization Rule Significantly Impacts Payers’ Approval and Denial Practices

McDermott Will & Emery on

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more

Arnall Golden Gregory LLP

Blue Cross Found to Be Behind the Times: Fifth Circuit Finds Blue Cross’ Proton Beam Treatment Guidelines Are Outdated, Superseded...

Background - Revisiting the topic from an article published earlier this year, another plaintiff has successfully challenged a commercial insurer’s internal Proton Beam Radiation Treatment (“PBT”) policy. PBT is a proven...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

Carlton Fields on

On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Manatt, Phelps & Phillips, LLP

[Webinar] Prenatal Vaccines in Medicaid & CHIP: Current State Payment Rates and Strategies to Increase Access - June 8th, 2:00 pm...

Prenatal vaccines provide important protection for pregnant women and newborns against communicable diseases such as whooping cough and influenza. However, fewer than one out of four pregnant women receives all federally...more

Manatt, Phelps & Phillips, LLP

[Webinar] Vital Access: How Policymakers Can Streamline the Cancer Care Journey - January 10th, 1:00 pm - 2:00 pm ET

Over the past 50+ years, there has been enormous progress in understanding the mechanisms that cause blood cancer. As a result, new and groundbreaking treatments have led to significantly improved blood cancer survival rates....more

Manatt, Phelps & Phillips, LLP

[Webinar] Access to Coverage and Care: Policy Trends in Medicaid, Medicare and the Commercial Market - October 6th, 1:00 pm - 2:00...

Join Manatt for the First of Our Imperatives Deep-Dive Sessions on the Topics You Voted Most Important to You. To benefit fully from America’s health care system, people need both timely access to health care services and...more

Zuckerman Spaeder LLP

[Webinar] A Step-by-Step Strategy for Maximizing Insurance Coverage Under ERISA - July 22nd, 2:00 pm - 3:00 pm ET

Zuckerman Spaeder LLP on

Building on our recent overview presentation “Six Lessons Patients and Providers Need to Know," we invite you to join us as we examine a single medical provider/patient encounter, in order to identify the concrete steps a...more

Health Care Compliance Association (HCCA)

Long-Haul COVID-19 Cases Are Potential Risk for Claim Denials

Report on Medicare Compliance 30, no. 17 (May 3, 2021) - With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk....more

Cozen O'Connor

Recent Bad Faith Cases Regarding Reasonableness of Medical Treatment

Cozen O'Connor on

In two recent cases, the courts showed substantial deference to patients’ treating physicians in determining the reasonableness of medical treatment. This deference appears to reflect a reluctance of courts to decide what...more

Health Care Compliance Association (HCCA)

Telehealth Risks Come into Focus; Some Payers Don't Cover Audio-Only

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more

K&L Gates LLP

Triage: Updates to Mental Health Parity in California and Nationwide

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In this week’s episode, Carla DewBerry and Kelsey Jernigan discuss issues in mental health parity in the context of recent California legislation. In particular, the presenters discuss how a new California bill has sparked a...more

Spilman Thomas & Battle, PLLC

COVID-19 and Unprecedented: Litigation Insights, Issue 21 - August 2020

This 21st edition of Unprecedented, our weekly update on COVID-19-related litigation, pairs defense victories with new claims. Lenders obtained the dismissal of a lawsuit claiming agent fees under the PPP program, and...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Spilman Thomas & Battle, PLLC

Unprecedented: COVID-19 Litigation Trends, Issue 15

This 15th edition of Unprecedented, our weekly update on COVID-19-related litigation, showcases new and evolving trends. This week we note how COVID-19 has accelerated a pre-existing trend toward class action litigation. And...more

American Conference Institute (ACI)

[Webinar] Navigating New Risks and Litigation Challenges Facing Payors in the COVID-19 Context and Beyond - May 13th, 12:00 pm -...

What will the post-pandemic world look like? What risks and challenges will it raise and how to navigate the new litigation landscape? These are the most relevant questions amid the pandemic. To respond to them and provide...more

Foley & Lardner LLP

Behavioral Health & Substance Abuse Services: Massachusetts Proposal Reflects Focus on Expanding Access and Coverage

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... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more

White and Williams LLP

Another Court Broadly Construes “Interrelated Wrongful Acts” Provision

A key component to any claims-made policy is the existence of an “interrelated wrongful acts” provision. Claims-made policies typically provide coverage only for claims first made during the given policy period. Interrelated...more

Farrell Fritz, P.C.

Medical Marijuana 104: Responsibilities of Health Insurers

Farrell Fritz, P.C. on

It will come as no surprise that patients who are thinking about getting certified for medical marijuana use have a number of questions relating to the cost of obtaining medical marijuana products....more

Baker Donelson

Three Things Health Care Employers Should Know About Affordable Care Act Section 1557

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Health care providers are likely familiar with the Affordable Care Act's (ACA) prohibitions on discriminating against the recipients of their services, but providers also must be mindful that the ACA may also make them...more

BakerHostetler

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claims

BakerHostetler on

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more

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