Health Plan & Provider Report Index Summary

BANKING

– HSAs growth, community banks, In Brief, 241

BCBS

See BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Arbitration, requirement not displayed before contract signature line unenforceable (Cal. Ct. App.), 480
– Ariz., 87 percent surveyed say health needs improvement, report, 120
– Chronic illness, standardized N.C. care and coverage agreement for 5 conditions, 400
– Copayments and deductibles

– – Generic drugs

– – – Chronic illness, N.C. waives, 38
– – – Independence BC of Pa. waives, 706

– – HMO BlueChoice overcharges, jurisdiction lacking (E.D. Mo.), 181

– DME

– – Antitrust, PPO network agreement with suppliers legal (6th Cir.), 535
– – Right to counsel, billing fraud trial postponement denial deprived supplier (Ala.), 452

– Electronic health records, Mass. insurer to use Google Health platform, 679
– ERISA claims processing requirements, widower challenging wife's delayed breast cancer treatment approval denied injunctive relief against insurer (N.D. Cal.), 481
– Excluded from network, providers' damages suit against affiliated insurers proceeds under AWP statute (E.D. Ark.), 22
– Experimental knee surgery, Tenn. coverage denial upheld (6th Cir.), In Brief, 70
– Fraud probes, 2007 recoveries exceeded $250 million as identity theft increases, study, 702
– Health insurance policy rescission

– – Cal. agency regulations under review, 59
– – Oversight hearing, Cal. regulator orders coverage reinstatement for some, 445
– – Plans must show enrollee deception (Cal. Ct. App.), 19; (pet for reh'g filed), 66; denied (Cal., rev sought), 173; (rev den), 378
– – Reinstated class action (Cal. Ct. App., vac and reh'g), 39; suit proceeds (revised opinion), 271; (Cal., rev den), 682

– HMOs

– – BlueChoice overcharges, jurisdiction lacking (E.D. Mo.), 181
– – Clinical pathology services, damages award for practice upheld where payment was withheld from hospital-based practice (Fla. Dist. Ct.), 478
– – Hospital rates, plan did not act as fiduciary when negotiating (E.D. Mich., recon den), 39
– – Standing, employer cannot sue over participant's self-pay request where insurers denied coverage as not medically necessary (E.D. Pa.), 504

– Hospitals

– – Contract, Alvarado agreement valid despite ownership change (Cal. Super. Ct.), 590
– – Inadequate charity care, interim attorney general sues CareFirst (D.C. Super. Ct.), 728
– – Misrepresentation, facility's suit over coverage proceeds (E.D. La.), 734

– Illegal postclaims underwriting, Los Angeles sues Wellpoint and BC subsidiaries (Cal. Super. Ct.), 445
– Independent review, commissioner need not follow recommendation to cover out-of-network multiple myeloma treatment (Mich.), 482
– Individual health insurance market, Mich. senate passes reform bill, 498; insurer should use surplus to modify rates, hearing officer says, 582
– Mental health, coverage properly denied for medically unnecessary residential treatment for emotional problems (D. Mass.), 42
– MEWAs, trust's claim for benefit surplus refund from Capital BC proceeds (M.D. Pa.), 408
– Out-of-network ASC, anti-assignment provision no bar to ERISA claims (D.N.J.), 302
– Over-the-counter Zyrtec, Mich. to pay, 177
– Part B, whistleblower's FCA claims proceed against carrier (S.D. Miss.), 213
– Part D, new Md. law authorizes subsidies from CareFirst, 586
– Physician reimbursement

– – Class action settlement approved (S.D. Fla.), 477
– – Reconstructive plastic surgeon, ERISA preempts state claims for participant's child (D. Conn.), 534

– Physician-specific price and quality data, Tenn. provides for members, 205; release delayed, 300
– Preexisting conditions, senate panel considers Mich. bill, hearing, 119
– Privacy, N.J. and federal probe of Horizon member data security breach, 176
– Provider reimbursement, RICO class action conspiracy claims against 20 plans dismissed (S.D. Fla.), 658
– Rates, N.C. online cost estimator for procedures, 95
– Specialty pharmacy, no breach of fiduciary duty claim against BC of Northeastern Pa. over termination of linked group health plan (M.D. Pa.), 244
– State reform, access expansion efforts hampered by budget shortfalls, report, 205
– Taxation, health insurance reform proposal includes federal tax credits, 122
– TennCare, request for medical and behavioral provider proposals, In Brief, 62; contracts awarded, 471

BONUSES

– HMOs, Cal. plans pay physician groups millions for quality improvements, 271
– Medicare Physician Quality Reporting Initiative, 16 percent of eligible providers participating, CMS says, 260; payments to be sent mid-July, 695
– Pay-for-performance programs pilot, timely CMS feedback lacking, GAO report, 233

BREACH OF CONTRACT

– HMOs, physician firing did not violate agreement or unfair trade practices law (Conn.), 68
– Hospitals, ERISA preempts claims based on benefits assignment (N.D. Ind.), 99
– Skilled in-home care for amputated leg, ERISA preempts widow's claims against CIGNA over denial (D. Me.), 353

BREAST CANCER

– Arbitration, patient whose plan acted in bad faith by rescinding coverage awarded millions, 245
– ERISA claims processing requirements, widower challenging wife's delayed treatment approval denied injunctive relief against BS (N.D. Cal.), 481
– Fraud, Los Angeles City Attorney sues Health Net for illegally terminating insurance coverage (Cal. Super. Ct.), 245

BUDGET, U.S.

– FY2008, omnibus funding bill

See LEGISLATION, FEDERAL, HR 2764

– FY2009

– – Employee benefits, tax preferences factor in debates as federal revenue need grows, report, 232
– – Medicare and Medicaid cuts proposed, 141; Bush plan to cut Medicare but not MA plans criticized, 167; Democrats charge Bush seeks to privatize Medicare, 199; House and Senate committees reject Bush cuts and approve plan giving Medicare physicians pay increases, 285
– – Resolutions

See LEGISLATION, FEDERAL, HConRes 312, SConRes 70