Health Plan & Provider Report Index Summary

BALANCE BILLING

– Disclosure of policies to patients, Natl. Ass'n of Ins. Comm'rs hearing, 1173
– Emergency services

– – Banned for managed care plans (Cal.), 41; impact explored, BNA Analysis, 393
– – Lawsuits expected to increase in light of recent Cal. rulings, 219

– Health care reform legislation impact, BNA Analysis, 1137
– Medi-Cal patients prevention, governor signs bill, 2023

BANKRUPTCY

– Medical debt, cited in 62 percent of filings, study presented at hearing, 919

BCBS

See BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

BILLING

– Balance billing

See BALANCE BILLING

– Credit for copayment discrepancy, plan beneficiary must exhaust administrative remedies before filing suit (N.D. Cal.), 1067
– Electronic claims processing requirement, savings expected under Minn. law, 866
– Fraud and abuse

– – Cardiologist, multiple-count conviction for improper billing of private insurers and federal programs (W.D. La.), 71
– – Chiropractic services, $1.2 million payment for restitution in back pain billing scheme (N.D. Ga.), 348
– – Medical transcription company, Kaiser Found. claim proceeds (D.N.J.), 461
– – Medicare Advantage

– – – Bogus treatments, 2 charged in 5-state scheme (S.D. Fla.), 590
– – – Improper billing, 8 Miami defendants charged (S.D. Fla.), 775

– – Staged automobile accidents, scam leader sentenced to 14 years in prison for private insurer fraud (S.D. Fla.), 894
– – Tests and screening, certification denied in class action alleging improper Quest Diagnostics billing (D.N.J.), 186

BIRTH CONTROL

See CONTRACEPTION

BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Administrative costs

– – Dropped in 2008, report, 932
– – Overstated, report, 982

– Anthem rate hike, Dodd (D-Conn) and state attorney general set hearing and urge reconsideration, 829; approval process revision sought, 977
– Antitrust, competitor insurer claims against Anthem properly dismissed for deficient pleading (6th Cir.), 9
– AWP, providers may sue for damages under Ark. statute (8th Cir.), 36
– Cardiologist, multiple-count fraud conviction for improper billing of private insurers and federal programs (W.D. La.), 71
– Chiropractic services, $1.2 million payment for restitution in fraudulent back pain billing scheme (N.D. Ga.), 348
– Chronic illness, care management and disease prevention key to overall health delivery system revision, guide, 506
– Conversion from nonprofit status, plan may be entitled to partial tax refund (M.D. La.), 862
– Disclosure, Del. regulator fines insurer for consumer privacy violations resulting from printing error, 74
– Discounts, Regence BS suit alleging members are not given negotiated rates dismissed absent provider participation in suit (W.D. Wash.), 710
– Electronic health records, Highmark funding for small primary care practices, 571
– Emergency services

– – Bayonne Hosp. sues Horizon over unethical tactics to deter use (D.N.J.), 891
– – GM participants sue over Mich. coverage denials, no ERISA fiduciary duty breach claim (E.D. Mich.), 413

– Employer did not pay premiums, former employees' claims for medical costs reimbursement denied but money submitted by workers recoverable (W.D. Ark.), 1030
– FEHBP enrollees premium costs to rise in 2010, OPM says, 1154
– Fertility treatment, coverage not required (Cal. Ct. App.), 864
– Fraud

See FRAUD AND ABUSE

– Full and fair review, BCBS of La. did not afford where new grounds were raised for denying benefits for bypass patient (5th Cir.), 379
– Grants, BS of Cal. Found. shifts money from health technology to universal coverage and safety net efforts, 108
– Individual policies

– – Anthem market conduct charges, $1 million paid to settle, 189
– – Los Angeles City Attorney's suit against Anthem BC proceeds (Cal. Super. Ct.), 130; stay denied, 501; temporary order stays trial court proceedings against Anthem BC (Cal. Ct. App.), 626; physicians file amicus brief, 979
– – Mich. rates, lawmakers adjourn without action, 16; insurer to cut jobs and seek increases to offset losses, 106; commissioner sets hearing, 681; increase approved, 978; Dingell (D-Mich) and Levin (D-Mich) ask for details on rate increases, 997
– – Notices, judge bars release of confusing second directive in class action against Anthem BC over rescissions (Cal. Super. Ct.), 131
– – Regence of Or., premiums increase approved, 595
– – Rescissions, California

– – – Directed verdict for insurer (Cal. Super. Ct.), 663
– – – Regulator enforcement action settled, 42

– Internet, online coverage options navigation tool, 956
– Laptop computer stolen from employee car has personal information on doctors, 2026
– Massachusetts

– – Health reform law, spending distribution unchanged, report, 437
– – Physician reimbursement, alternative pay system contract with Atrius signed, 896
– – Zoladex pricing for AWP compendiums unfair and deceptive, AstraZeneca appeal of $12.9M judgment denied (1st Cir.), 1128

– Medically necessary services, class action alleges regular payment denial by Anthem (Cal. Super. Ct.), 292; treatment approved in coverage reversal, 314
– Medicare Advantage, CMS estimates 0.5 percent reimbursement increase in 2010, 208; CMS may consider physician pay when calculating rates, BCBSA says, 337; 0.81 percent is actual rate, 403
– Medigap policies, Mich. plan warned about deceptive business practices, 16
– Mental health, claims over residential treatment coverage denial proceed (N.D. Cal.), 1029
– Mergers

See MERGERS AND ACQUISITIONS

– Mont., insurance forms exclude coverage of injuries covered by other policies, prohibition on use affirmed (Mont.), 1160
– N.D., insurance regulator calls on company to review compensation and travel policies, 1074
– Omega Hosp., trial over Mich. reimbursement proceeds (E.D. La.), 376
– Out-of-network care

– – ERISA no bar to claim over patient incentives to change surgical services providers (D.N.J.), 530
– – Hospitals, Anthem files suit over use of manipulated information to underpay (Cal. Super. Ct., C.D. Cal.), 921
– – Hospitals sued over waiver of patient costs (N.J. Super. Ct.), 677
– – Medicare Secondary Payer Act not violated by reimbursement at lower rates (N.D. Ga.), 261

– Overpayments

– – Omega Hosp., trial over Mich. plan reimbursement proceeds (E.D. La.), 376
– – State medical association sues contractor (Tenn. Ch. Ct.), 744

– Physician ratings, Tex. to stop using cost-based system, 435
– PPOs

– – Anthem of Ind., affordable fixed-rate option, 391
– – Insurer and Miami-Dade County launch new product to cover uninsured, 654

– Prescription drugs

– – Generic, consumer use expansion campaign, survey, 440
– – Plavix, Independence did not violate ERISA benefit plan terms by assigning medication without generic version to highest tier (E.D. Pa.), 706
– – 2-state CVS pilot on giving instant access to prior authorizations, 570

– Prompt payment, ERISA preempts Mo. physician's state law claims (S.D. Fla.), 158
– State legislation, health reform shift from coverage expansion to SCHIP, report, 220
– Workers' compensation insurance fund, Blue Cross network use for claims no violation of antitrust laws (Cal. App. Ct.), 1103

BONUSES

– Colo. insurance claim denials, senate bill to ban passed, 384

BREACH OF CONTRACT

– Attorneys' fees, award for sponsor upheld when ERISA plan's third-party administrator removed state law action to federal court (6th Cir.), 12
– ERISA preemption

– – Claims processing errors by third party administrator alleged, ERISA does not preempt (D. Mass.), 2020
– – Hospital state law claims for benefits against health plan administrator not barred (9th Cir.), 1062
– – Improper health insurance coverage termination, employer's state law claim barred (N.D.N.Y.), 621
– – Physician shareholder's claims against practice group proceeds (W.D. Tenn.), 708

– Exhaustion of remedies, Medicare law preempts cancer patient's claims against Humana (S.D. Fla.), 288
– PPOs

– – Chiropractic services, claims proceed against insurer (S.D. Ill.), 347
– – Physician group denied class certification (C.D. Ill.), 157

– Preferred Care Partners/Humana acquisition, claims over alleged breach of confidentiality agreement proceed (S.D. Fla.), 495
– Risk pool for major medical insurance policy, alleged mishandling caused premiums to rise, claim allowed (D.N.J.), 1100

BREAST CANCER

– Hospital stay benefits restriction, insurers prohibition

See LEGISLATION, FEDERAL, HR 1691

– Mammograms for screening purposes

See LEGISLATION, FEDERAL, HR 995

– Public health campaign aimed at young women

See LEGISLATION, FEDERAL, HR 1740

– Treatment quality measures establishment

See LEGISLATION, FEDERAL, HR 2279

BUDGET, U.S.

– FY2010 proposal

– – Medicare and Medicaid cuts, $316 billion over 10 years, 249; spending would be reduced by $295 billion, CBO report, 334; final proposal would cut program spending by $309 billion to fund health reform, 557; President defends program spending reductions in address to AMA, meeting, 692; Obama proposes $313 more program cuts, 694
– – MA competitive bidding system included, 255

– Resolution

See LEGISLATION, FEDERAL, SConRes 13