News & Analysis as of

Health Insurance

Virginia, Maryland, and kids bear early brunt of partisan health care attacks

As the nation churns toward the midterm elections, the Trump Administration has sent stark messages to voters about how they may wish to respond to Republicans’ unceasing attacks on health care and health insurance for the...more

Direct Contracting 101: Collaborations Between Employers and Health Care Providers

by Jones Day on

As employers continue to encounter escalating health care costs, many are exploring the "direct contracting" option, which allows for direct service and pricing negotiations with health care providers. While the direct...more

Can a Dominant Health Insurer’s Refusal to Negotiate in Good Faith Be Actionable under the Antitrust Laws? Yes, Says a Federal...

by Polsinelli on

On April 23, a federal court in Rhode Island fired a warning shot over the bow of dominant health insurers across the country, holding that a refusal to negotiate in good faith with a healthcare provider that focuses...more

K&L Gates Triage: Pharmacy Gag Clauses & Clawbacks

by K&L Gates LLP on

Pharmacy Benefit Managers (PBMs) are increasingly utilizing gag clauses in pharmacy contracts as a means of prohibiting pharmacies from telling customers that paying for drugs out of pocket would cost them less than if they...more

Nebraska Adopts Reinsurance Credit Amendments To Insurance Law Based On NAIC Model

by Carlton Fields on

On April 11, 2018 Nebraska Gov. Pete Ricketts (R) signed Legislative Bill 815 into law, joining the surge of states amending their insurance laws regarding when ceding insurers may claim credit for reinsurance....more

2019 Health Plan Design Considerations

by Winstead PC on

2019 HDHP and HSA Limits - Since many employers are working on their health plan designs for calendar year 2019 during the month of May, the Internal Revenue Service just issued the HDHP and HSA limits shown below for...more

Health Insurance Quality Assurance Included Doctor Visits

By signing a health insurance enrollment form, a plaintiff consented to receive quality assurance calls about her medical provider, the U.S. Court of Appeals, Ninth Circuit held in affirming summary judgment in favor of the...more

Game Over? Ninth Circuit Doubles Down on Its Commitment To Enforcing Anti-Assignment Provisions In ERISA Plans To Bar Suits By...

by Seyfarth Shaw LLP on

SEYFARTH SYNOPSIS: The Ninth Circuit recently dealt another major blow to healthcare providers that attempt to bring suits as assignees of their individual patients, holding that an ERISA plan’s anti-assignment provision bars...more

Welcome to The Garden State: NJ’s Law Against Discrimination Grows to Protect Non-Resident Employees

by Genova Burns LLC on

A New Jersey appellate court recently held that a non-resident employee who telecommuted to her New Jersey employer from her home in Massachusetts may be covered by the New Jersey Law Against Discrimination (NJLAD). Facts -...more

New Mental Health Parity Guidance and Enforcement Efforts May Warrant a Deep Dive Into Plan Administration

The Department of Labor (DOL), the Department of the Treasury, and the Department of Health and Human Services (HHS) are making good on their promise to issue more guidance and to aggressively enforce the federal Mental...more

Health Care Policy Newsletter

by Foley & Lardner LLP on

Foley & Lardner LLP’s (“Foley”) Bipartisan Public Policy Team is pleased to share our second “Public Policy Weekly* Health Care Newsletter” in which we compile the latest health care policy news and legislation. Please...more

Insured Plaintiff Who Treats Outside Medical Plan on Lien Basis is Deemed Uninsured Under the Law Allowing Potential Recovery for...

This week, the California Court of Appeal, Second Appellate District, Division Six held in Pebley v. Santa Clara Organics, LLC et al., (No. B277893) that an insured plaintiff who elects to treat out-of-network shall be...more

Recent Appellate Decision Favors Plaintiffs in Valuation of Past Medical Damages

by Selman Breitman LLP on

The Implications of Pebley v. Santa Clara Organics, LLC - The Court of Appeal's recent holding in Pebley v. Santa Clara Organics, LLC allows insured plaintiffs to potentially recover the full amount billed for medical...more

California Court Of Appeal Holds That Disclosure Of Confidential Information Protected By Anti-SLAPP Statute

by Seyfarth Shaw LLP on

A recent California Court of Appeal decision held that the receipt, retention and dissemination of confidential information by a whistleblower’s attorney is protected by the state’s anti-SLAPP statute. MMM Holdings, Inc. v....more

Vermont Legislative Update 5-4-18 - An analysis from DRM's Government & Public Affairs Team

Medical Monitoring Bill Moves On - The House Judiciary Committee sent a version of S.197 to the Senate floor that eliminates the Senate-passed provisions creating strict, joint and several liability for release of harmful...more

Can I Waive a Patient’s Co-Pay?

by Burr & Forman on

I am occasionally asked by providers whether or not they can waive a co-pay for a particular patient. There are many reasons providers wish to waive co-pays: financial hardship, professional courtesy, employee discounts, etc....more

IRS readjusts HSA contribution limit

by Bricker & Eckler LLP on

In March of this year, the IRS adjusted the 2018 HSA contribution limit for individuals enrolled in family coverage down $50 from $6,900 to $6,850. A little over a month later, the IRS reconsidered the retroactive limit...more

Can Republican-Led States Succeed in Enjoining the Affordable Care Act?

by Locke Lord LLP on

Beginning January 1, 2019, the Tax Cuts and Jobs Act of 2017 reduces to zero dollars the Affordable Care Act (ACA) tax penalty imposed on many individuals who fail to maintain minimum essential coverage (i.e., the individual...more

Managing Medical Bills and Insurance Paperwork: 7 Tips for Maximizing Reimbursement

Do you become frustrated and overwhelmed when managing medical bills and filing health insurance claims? Managing and filing insurance claims can be a complex, frustrating, stressful, confusing and time-consuming process,...more

Revenge of the HIRDs—The New Massachusetts Employer Healthcare Coverage Form

In a series of recent posts, we discussed the expanded Massachusetts Employer Medical Assistance Contribution (EMAC) requirements, including the adoption of a new EMAC supplemental contribution. Among other things, we...more

IRS Reverses Position on 2018 Family Contribution Limit for HSAs

The Internal Revenue Service originally announced in 2017 that the 2018 contribution limit for health savings accounts (HSAs) corresponding to family coverage under a high-deductible health plan would be $6,900. Then, in...more

Relief Provided for 2018 Family HSA Contribution Limit

by Seyfarth Shaw LLP on

On April 26, 2018 the IRS issued Revenue Procedure 2018-27 providing transition relief for the 2018 limit on Health Savings Account (“HSA”) contributions for family coverage. The guidance allows individuals to continue to...more

News from Second & State

Last week, the Senate was the only chamber in session. This week, it was the House of Representatives’ turn to be in Harrisburg for three session days. On Monday, the House Consumer Affairs Committee held a public hearing...more

Much Ado about $50… IRS Announces Relief for Reduction of Maximum HSA Contributions

by Snell & Wilmer on

On April 3, we blogged about a reduction in the HSA contribution limit for family coverage in 2018 from $6,900 to $6,850. This was a technical change resulting from the Tax Cuts and Jobs Act that adjusted the method for...more

Clawbacks: Recent Litigation Targeting Insurers and Pharmacy Benefit Managers

While the term “co-pay” might suggest a sharing of costs between patients and their health plans, a recent study by the University of Southern California Schaeffer Center found that almost a quarter of patients are paying...more

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