Health Plan & Provider Report Index Summary

CALIFORNIA

– Budget, signed revision includes $2 billion in health care cuts, 928
– CalPERS

– – Anthem BCBS reimbursement, class action alleges regular payment denial for medically necessary services (Cal. Super. Ct.), 292; treatment approved in coverage reversal, 314
– – COBRA, lawmakers approve subsidy notification bill, 568
– – Demonstration projects, risk sharing to cut costs and improve outcomes, 503
– – E-prescriptions, pilot project, 387
– – Governor proposes coverage revision to cut costs, 72; final budget lacks provision to change agency administration, 267
– – HMO offering greater transparency sought, 160
– – Premiums, 2010 increase of 2.9 percent is lowest in years, 745

– Children's health care, group seeks changes to policy allowing plans to deny medically necessary treatment for autism, 265; state regulatory clarifies coverage requirements, 316; court order sought to require coverage (Cal. Sup. Ct.), 802
– Electronic health records

– – CalRHIO exchange initiative, UnitedHealthcare supports, 653
– – Octuplets' mother, agency fines Kaiser hospital for information breach, 595; fine for second privacy violation, 867
– – State agency provides grants for Los Angeles County, 223

– Emergency services

– – Balance billing, lawsuits expected to increase in light of recent rulings, 219
– – ERISA does not preempt state law requiring plans to reimburse providers for member care (Cal. Ct. App.), 593

– Fertility treatment, BCBS not required to cover (Cal. Ct. App.), 864
– Fraud, guilty plea entered by recruiter of healthy patients for unnecessary surgeries (Cal. Super. Ct.), 264
– Grants, BS of Cal. Found. shifts money from health technology to universal coverage and safety net efforts, 108
– Health insurance

– – Anti-assignment policy provision, no violation of state law (Cal. Ct. App.), 566
– – BCBS individual policy rescissions

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

– – Cease and desist orders, state issues to 2 medical discount health plans, 1069
– – Claims processing, agency sets PacifiCare hearing, 721
– – Coverage mandates, lawmakers pass bills, 1102
– – Health Net rescissions, class action settled with agreement to reimburse policyholder medical costs (Cal. Super. Ct.), 190; hospitals' settlement, 650
– – Individual market

See Individual health insurance market, this heading

– – Los Angeles City Attorney's suit against Anthem BC over individual policy rescissions 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
– – Managed care plans, emergency services balance billing banned (Cal.), 41; impact explored, BNA Analysis, 393
– – Market conduct charges, Anthem pays $1 million to settle, 189
– – Medical discount health plans, regulators to license, 713
– – Mental health, claims against BCBS over residential treatment coverage denial proceed (N.D. Cal.), 1029
– – Negligence, member claim against plan administrator over lung cancer treatment denial reinstated (Cal. Ct. App.), 498; right to independent medical review important to patients, 499
– – Notice, judge bars release of confusing second directive in class action against Anthem BC over individual policies rescissions (Cal. Super. Ct.), 131
– – Out-of-network care, denial proper where Medicare beneficiary did not prove medical necessity or superiority of surgery plan covered (9th Cir.), 261; subpoenas ruling by administrative law judge (U.S., rev sought), 1157; (rev den), 2020
– – San Francisco fair share ordinance requiring employer-paid health coverage

– – – No ERISA preemption (9th Cir., en banc rev sought), 39; restaurant group seeks stay from Justice Kennedy as Circuit Justice (U.S., application filed), 342; (stay denied), 375; (U.S., rev sought), 704; (amicus brief filed), 825; (brief filed), 1023; Solicitor General Kagan invited to file briefs, 1185
– – – Pay-or-play rules, employers adapting to ordinance, 629

– – Standing, spouse cannot sue insurer for misrepresentation of terms of policy covering late wife (Cal. Ct. App.), 500
– – Translation from English, rule require as necessary, 415
– – Underwriting and rescissions

– – – Individual policies, state lawmakers pass bills, 1102; governor vetoes and signs bills, 2022
– – – State agency issues proposed rule, 678

– – Unions, state regulator shuts down bogus health plan, 829

– HMOs

– – CalPERS, organization offering greater transparency sought, 160
– – Computer theft of private data, 30,000 Kaiser workers affected, 191
– – Credit for copayment discrepancy, plan beneficiary must exhaust administrative remedies before filing suit (N.D. Cal.), 1067
– – Data management, agreement with IBM cuts hundreds of Kaiser jobs, 352
– – Kaiser Permanente job cuts, 982
– – Physician reimbursement suit dismissed where capitation agreement with unlicensed firm was illegal and unenforceable (Cal. Ct. App.), 104

– Hospitals

– – Emergency care

See Emergency services, this heading

– – External review organization and plan administrator, facility's claims alleging underpayment proceed (E.D. Cal.), 1002
– – Kidney transplant patients, Kaiser settles for $1 million, 494
– – Managed care plans, emergency services balance billing banned (Cal.), 41; impact explored, BNA Analysis, 393
– – Out-of-network care, Anthem BCBS sues over use of manipulated data to underpay (Cal. Super. Ct., C.D. Cal.), 921
– – Public plan option would cause financial losses, study, 867
– – Referral practices, facility sues Scripps Health (Cal. Super Ct.), 712
– – State law claims alleging insurer's claims processor intentionally interfered with contractual relations proceed (E.D. Cal.), 156

– Individual health insurance market

– – Application misrepresentations or omissions, proof needed before rescission, lawmakers approve bill, 1102; governor vetoes bill, 2022
– – Bills passed barring gender-based discrimination, 592
– – Post-claims underwriting fines, lawmakers approve bill, 1102; governor vetoes bill, 2022
– – Rescission prohibition once coverage in force for 2 years, lawmakers approve bill, 1102; governor signs bill, 2022
– – Several bills passed, 719
– – Suit filed to end higher premiums for women (Cal. Super. Ct.), 129

– Managed care, timely nonemergency rules issued, 188
– Medi-Cal

– – Balance billing of patients prevention, governor signs bill, 2023
– – Changes, several bills passed, 719
– – Cuts planned, 651; court blocks (9th Cir.), 824; injunction barring rate cuts again upheld, 975
– – Gross premiums tax on managed care plans, governor signs bill, 1132
– – Hospital reimbursement rates increase, governor signs bill, 2023
– – Managed care of beneficiaries, delegation of responsibility for payments to emergency service providers disallowed (Cal. Super. Ct.), 1070
– – Temporarily unemployed beneficiaries in working disabled program, governor signs benefits extension bill, 2023

– Medicare overpayments, imposition of over $904,000 in interest not unfair to Kaiser (N.D. Cal.), 826
– Negligence, ERISA no bar to state claim against Aetna for releasing address to ex-husband who harassed insured (C.D. Cal.), 621
– Network provider treatment denial, impact of ruling rejecting vicarious liability of plans discussed (Cal. Ct. App.), audio conference, 496
– Nonemergency care, state agency issued revised rules for telephone triage, 801
– Omnibus health care reform bills introduced, 295
– Patient privacy statute, ambiguity examined, BNA Analysis, 751
– Payment and review of provider claims by plan operators, attorney general opens investigation, 1069
– Physician groups, FTC settles price fixing charges, 7
– SCHIP, cuts planned, 651
– Uninsured persons, San Francisco program has improved access, report, 1033
– Workers' compensation insurance fund, Blue Cross network use for claims no violation of antitrust laws (Cal. App. Ct.), 1103

CANCER

– Affordable post-diagnosis insurance problematic, report, 164
– Breast cancer education and patient care bills

See LEGISLATION, FEDERAL, HR 995, HR 1691, HR 1740, and HR 2279

– Cervical cancer screening tests, Cal. passes health insurance coverage mandate bill, 1102
– Exhaustion of remedies, Medicare law preempts patient's fraud and breach of contract claims against Humana (S.D. Fla.), 288
– Leukemia, ERISA plan must pay for medically necessary bone marrow transplant where coverage denial was arbitrary (N.D. Ohio), 260; order to pay reversed and remanded (6th Cir.), 1063
– Lung, negligence claim against plan administrator over treatment denial reinstated (Cal. Ct. App.), 498; right to independent medical review important to patients, 499
– Medications orally administered, Cal. passes health insurance coverage mandate bill, 1102
– Ovarian, class action alleges regular payment denial by Anthem BCBS for Avastin treatment drug (Cal. Super. Ct.), 292; approved in coverage reversal, 314

CARDIOLOGY

– Cholesterol-lowering medications, state worker health plan sues Vytorin and Zetia makers alleging deceptive marketing practices (E.D. Pa.), 707
– Full and fair review, BCBS of La. did not afford where new grounds were raised for denying benefits for bypass patient (5th Cir.), 379
– Tex., new law requires coronary disease screening coverage, 744

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

– Acting administrator, current CEO Frizzera, 61
– GINA implementation, regulatory agenda, 589; interim final rules released, 1152
– MHPAEA implementation, agency seeks public comment in advance of future rulemaking, 488; business groups seek clarification, 644; industry representatives cite enforcement concerns, 671; senators call for prompt release of rules, 943; HHS aims to issue rules by Jan. 2010, 1177
– Subregulatory guidance, compliance risks defined and discussed, BNA Analysis, 77

CHARITY CARE

– Me. hospitals, constitutionality of state law requiring treatment upheld (1st Cir.), 951
– N.J. funding, new law raises health insurance premium tax rates for one year, 828

CHILDREN'S HEALTH CARE

See also PREGNANCY AND CHILDBIRTH
– Affordable coverage options

See LEGISLATION, FEDERAL, HR 193, HR 194

– Autism

See AUTISM

– Dental services access for low-income children under Medicaid managed care needs to improve, GAO report, 1183
– Developmental screenings for infants and toddlers, Del. governor signs mandated benefits bill, 1073
– Gross premiums tax on Medi-Cal managed care plans, Cal. governor signs bill, 1132
– Hearing aids

– – N.J. law mandates coverage, 43
– – Or. mandated benefit, In Brief, 803
– – Wis., new law also requires cochlear implants coverage, 653

– High-risk pools, preexisting conditions coverage eligibility under new S.D. law, 680
– Overweight infants, Rocky Mountain Health Plans of Grand Junction reverses policy of denying coverage, 2026
– Reform, needs of older adults also critical, hearing, 699
– SCHIP

See STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP)

– Uninsured young adults

See UNINSURED PERSONS

– W.Va. Medicaid, eligible children may sue managed care program (S.D. W.Va.), 623

CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT

– Dental coverage requirements, CMS issues guidelines to states, 2018

CHIROPRACTIC SERVICES

– Breach of PPO contract, claims proceed against insurer (S.D. Ill.), 347
– Exclusion of providers from network upheld (Tenn. Ct. App.), 383
– Fraud and abuse, $1.2 million payment for restitution in back pain billing scheme (N.D. Ga.), 348
– State insurance laws violated, Mo. settlement, 1031

CHRONIC AND TERMINAL ILLNESS

– Demonstration projects

– – Care management, CMS ability to lead challenged by MedPAC, 305
– – Medicare disease management, limited impact of interventions, report, 33; AMA study confirms, 178

– Employee benefits, company costs increased 30 percent in 2008, survey, 318
– ESRD

See END-STAGE RENAL DISEASE (ESRD)

– Federal health care reform

– – Delivery system revision, care management and disease prevention key, BCBS guide, 506
– – Treatment and prevention key focus, stakeholders meeting, 432; White House Office for Health Reform Director DeParle optimistic, 432

– Part D coverage gap, House Democrats' proposal costly for chronically ill beneficiaries, news release, 798

CLAIMS PROCESSING

– Bonuses for insurance claim denials, senate bill to ban passed, 384
– Cal., attorney general opens investigation into payment and review of provider claims by plan operators, 1069
– Electronic billing requirement, savings expected under Minn. law, 866
– Hospitals, state law claims alleging insurer's processor intentionally interfered with contractual relations proceed (E.D. Cal.), 156
– HRAs, Medicare payment errors source, conference, 306
– ICD-10 coding conversion

See CODING

– Improvements noted but insurer efficiency challenges remain, AMA report card, 900
– Insurers' deceptive practices, Senate panel releases report on database creation, 768
– Medicare Part A and B, CMS contractor provider satisfaction survey for 2009, 1096
– PacifiCare, Cal. agency hearing set, 721
– Payment delays

See PROMPT PAYMENT

– Third party administrator not liable as “functional” fiduciary for alleged errors, “named” fiduciary status unresolved (D. Mass.), 2020

CLASS ACTIONS

– Aetna underpricing to gain market share, securities suit alleging misrepresentation dismissed (E.D. Pa.), 742
– Autism treatment, no ERISA breach of fiduciary duty claim against BCBS over therapy denial (E.D. Mich.), 312; certification denied, 413
– AWP, settlements approved in suits against database publishers (D. Mass.), 345; chain drugstores to appeal, 531; court approves McKesson accord, 951; pharmacy interest groups lose appeal (1st Cir.), 1065
– BCBS individual policy rescissions, judge bars release of confusing second directive in suit against Anthem BC (Cal. Super. Ct.), 131
– Celebrex and Bextra safety, global settlement approved (N.D. Cal.), 380
– Eating disorders, Horizon BCBS of N.J. settlement of coverage claims for dependents approved (D.N.J.), 494
– ERISA, growing number of complex lawsuits raise certification issues, BNA audio conference, 1126
– Health Net rescissions, suit settled with agreement to reimburse policyholder medical costs (Cal. Super. Ct.), 190; hospitals' settlement, 650
– HMO underpayment for services alleged, sanction order vacated (3d Cir.), 1061
– Hospitals charged uninsured unreasonable rates

– – Advocate Health Care agrees to settle (Ill. Cir. Ct.), 125
– – Resurrection Health Care settlement approved (Ill. Cir. Ct.), 69

– Medical reimbursement rate dispute, Allstate settles suit over automobile and homeowner claims (Ill. Cir. Ct.), 1003
– Medically necessary services, suit alleges regular payment denial by Anthem BCBS (Cal. Super. Ct.), 292; treatment approved in coverage reversal, 314
– Out-of-network reimbursement

– – AMA suit challenging UnitedHealth system settled (S.D.N.Y.), 57; trial court delays accord approval, 649
– – CIGNA and Aetna databases, AMA and state medical societies file suits alleging knowing underpayment (D.N.J.), 184
– – WellPoint sued over use of Ingenix data (C.D. Cal.), 381

– PPOs, physician group denied certification in breach of contract suit (C.D. Ill.), 157
– Tests and screening, certification denied in suit alleging improper Quest Diagnostics billing (D.N.J.), 186
– Uninsured patients allege hospital overcharges violate state law, certification denied (Ala.), 1131
– Vytorin and Zetia, Merck and Schering-Plough settle suit over failure to disclose unfavorable clinical test results (D.N.J.), 953

CLINICAL LABORATORIES

– Horizon BCBS sues over fraudulent claims (N.J. Super. Ct.), 830

CLINICAL TRIALS

– Colo., house approves bill requiring health plans to cover, 222; new law, 567
– Or., bill passed requiring cost coverage, 680; new law, In Brief, 747
– Vytorin

– – Delay in study results caused plan losses, Merck employees ERISA claim can proceed (D.N.J.), 1064
– – Merck and Schering-Plough settle class action over failure to disclose unfavorable test results (D.N.J.), 953

– Zetia, Merck and Schering-Plough settle class action over failure to disclose unfavorable clinical test results (D.N.J.), 953

CMS

See CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Denials, new CMS website to expedite reviews, 861
– ERISA, no preemption of disabled casino worker's claim for additional medical payments (E.D. Mo.), 565
– Kan., new law consistent with federal requirements, 464
– N.Y., eligibility extended under economic stimulus package, 349
– Notice

– – Hospitals, early retirees entitled although afforded other health benefits in benefit packages (W.D. Va.), 11
– – Requirements, Labor Dep't seeks comments, 618; deadline Sept. 23, 1027

– Pa. access expansion bill set for vote, 416
– Premium payment untimely, Treasury Dep't rule does not excuse so as to avoid coverage cancellation (11th Cir.), 1004
– Retention assistance for those who lose jobs

See LEGISLATION, FEDERAL, HR 1, HR 598, S 1

– “Sham termination,” not qualifying event for entitlement (S.D. Tex.), 381
– Subsidies, economic stimulus

– – Adversely affected plans, IRS may offer relief, 524
– – American Recovery and Reinvestment Act

– – – Attorneys and agency officials discuss key compliance issues, webcast, 254
– – – CalPERS, lawmakers approve notification bill, 568
– – – Eligible plan participants, 500,000, survey, 489
– – – Premiums assistance, enrollment doubled, report, 1009
– – – Questions raised for employers and insurers, Special Report, 270

– – Baucus (D-Mont) plan includes, 94
– – Denials, Labor Dep't issues appeal guidelines, 610
– – Model notices, DOL issues, 332; guidance expanded, 406

– Temporary relief, rapid action expected, 214
– Utah alternative, new law, 314
– Violations do not constitute fiduciary acts under insurer's liability policy (5th Cir.), 216

CODING

– ICD-9, CMS says general equivalence mapping expands system, 612
– ICD-10 transition, HHS delays rule implementation until 2013, 60; delay canceled, In Brief, 310; patient and provider benefits cited, summit, 456; CMS urges provider planning, 563; introductory fact sheet revised, CMS releases, 1184

COLLEGES AND UNIVERSITIES

– Fla. state university students, house passes bill requiring private insurance use, 503
– Georgetown Univ., health reform project papers describe legal issues and possible solutions, In Brief, 414
– Tex. college student health coverage bills passed, 716; vetoed, 744
– Young adults from 19 to 29, lawmakers urged to require health coverage under parents' plans, 946

COLORADO

– Autism, coverage required under new law, 679
– Bonuses for insurance claim denials, senate bill to ban passed, 384
– Clinical trials, house approves bill requiring health plans to cover, 222; new law, 567
– E-prescribing and personal health records, panel recommends increased use, report, 534
– HMOs

– – Enrollment drops as profits increase, report, 223
– – Limited benefit plans, new law allows, 498

– Hospitals

– – Avoidable medical errors, executive order signed to deny Medicaid payments, In Brief, 417
– – Binding arbitration hearing set in suit over sale of 3 facilities (Colo. Dist. Ct.), 73; 2 sales disallowed for violation of state nonprofit law but third proceeds, 712; agreement to transfer 2 Exempla properties to Catholic system, 1007
– – Provider fee, governor proposes to cover expanded SCHIP and Medicaid, 107; house approves, 385; senate approves bill, 438; new law, 504

– Individual policies, state fines UnitedHealthcare companies for coverage and claims violations, 1193
– Physician groups, FTC settles price fixing charges, 7
– Small businesses health insurance, number of covered workers drops, report, 777
– Wellness programs, plans may provide incentives under proposed bill, 161; new law, 500

COMMUNITY CENTERS

– Ariz. Medicaid, order upheld requiring state to improve access for disabled recipients (D. Ariz.), 531

COMPARATIVE EFFECTIVENESS RESEARCH

See RESEARCH

CONFERENCES AND MEETINGS

– Ed. Note: The Journal section of each issue provides a list of upcoming conferences and meetings and a list of documents available from BNA PLUS.
– ABA

– – Am. Law Inst.

– – – Conference, 2013
– – – Webcast, 254

– – Health Law Section panel meeting, 439
– – Section of Taxation meeting, 587

– Academy-Health conference, 122
– Agency for Healthcare Research and Quality Natl. Advisory Council public meeting, 409
– Am. Enterprise Inst. forum, 352
– Am. Health Info. Mgmt. Ass'n summit, 456
– Am. Health Ins. Plans

– – Administrative services automation in physicians' offices and hospitals, initiative announced at teleconference, 1195
– – Medicare and Medicaid Conferences, 2009, 1096
– – Natl. Policy Forum, 306

– Am. Health Lawyers Ass'n

– – April audio conference, 496
– – Hosp. Law Inst. meeting, 177

– AMA House of Delegates meeting, 692; 749
– BNA

– – ERISA class action certification issues arise from growing number of complex lawsuits, audio conference, 1126
– – Fraud audio conference

– – – Feb. scheduled, In Brief, 127
– – – Jan. set, In Brief, 8

– – HIPAA and information technology funding, audio conference, In Brief, 286
– – Medical tourism, legal issues audio conference, In Brief, 187

– Brookings Inst. panel discussion, 821
– Business of Medicare Advantage Forum 2009, 117; 151
– Capitol Hill forum, 370
– Center for American Progress Action Fund meeting, 371
– Center for Business Intelligence

– – 8th Annual Strategic Medicare Policy Summit, 178; 211
– – Online seminar, 1036

– CMS conference on Medicare compliance, 763
– Council for Affordable Health Ins. briefing, 833
– Crowell & Moring LLP teleconference, 179
– eHealth initiative webinar, 465
– Employers Council on Flexible Compensation conference, 306
– Ernst & Young webcast, 884
– Families USA conference, 123
– HHS Office of the Natl. Coordinator for Health Information Tech. meeting, 795
– HIT Symposium at MIT, 793
– Intl. Assn. of Privacy Professionals Privacy Summit '09, 319; 352
– Medicare Marketing Strategies meeting, 373
– Natl. Comm. to Preserve Soc. Sec. and Medicare meeting, 615
– Natl. Gov. Ass'n winter meeting, 265
– Second Annual Kaiser Health Care forum, 930
– Trucker Huss law firm webcast, 717
– Understanding the 2009 Economic Stimulus and Other Challenges webinar, 410
– U.S. Chamber of Commerce conference, 97
– White House Forum on Health Reform, 279
– World Health Care Congress's 5th Annual Leadership Summit on Medicare, 849

CONFIDENTIALITY

See PRIVACY AND CONFIDENTIALITY

CONFLICTS OF INTEREST

– Derivative standing, provider receiving assignment of benefits from ERISA participant entitled to copies of plan documents (E.D. La.), 99
– PBM, federal law preempts D.C. disclosure law (D.D.C.), 331

CONGRESS, U.S.

– Ed. Note: This heading is used for administrative actions only. For coverage of legislation by bill number, see LEGISLATION, FEDERAL. For information on measures not yet assigned numbers, see specific subject headings.
– Senate Health, Education, Labor, and Pensions Comm.

– – Chairman, Harkin (D-Mass) accepts position, In Brief, 1060
– – Jan. 8 hearing set on HHS secretary nominee Daschle, In Brief, 8; bipartisan cooperation promised, 33; Daschle withdrawal may delay reform efforts, 149

CONNECTICUT

– Anthem BCBS rate hike, Dodd (D-Conn) and state attorney general set hearing and urge reconsideration, 829; approval process revision sought, 977
– Lobbying expenditures of insurance companies re health care reform, AFL-CIO seeks state investigations, 1133
– Universal health coverage, veto override of health reform package, 882

CONSTITUTION, U.S.

– First Amendment

See FIRST AMENDMENT

– Individual mandate in health care reform bills, critics raise concerns, BNA Analysis, 1165
– Standing

See STANDING

– Takings Clause, Me. law requiring hospital charity care upheld (1st Cir.), 951

CONSUMER-DIRECTED PLANS

– Cooperatives, Conrad (D-ND) proposes, 666; idea draws interest, 695
– Employer savings and improved care quality, Aetna study, 320
– Important part of overall health reform effort, briefing, 833
– Public sector employers, disease management and wellness programs favored, report, 108

CONSUMER PROTECTION

– Balance billing

– – Disclosure of policies to patients, Natl. Ass'n of Ins. Comm'rs hearing, 1173
– – Health care reform legislation, BNA Analysis, 1137

– Cal. medical discount health plans

– – Cease and desist orders, state issues to 2 companies, 1069
– – Regulators to license, 713

– Electronic health records security breaches, proposed FTC rule on consumer notice, 453; commission urged to adopt HHS approach, 668; final rule issued, 973; interim final HHS rule includes delayed enforcement date and risk of harm notification threshold, 995; harm provision, House committees leaders urge HHS to revise, 1180
– Health insurance

– – Policy benefits labeling system recommended, report, 570
– – President urges public support, 916
– – Profits valued over members, Senate panel hearing, 767; Rockefeller (D-WVa) calls for CIGNA clarification of small businesses policy purging, 941
– – Purging of small business policies, House panel investigates, 1056

– Individual policies, Colo. fines UnitedHealthcare companies for coverage and claims violations, 1193
– Long-term and home health care plans, Minn. attorney general alleges fraud and sues Home Health Am., 1193
– Low-cost plan, Minn. attorney general alleges fraud and sues Consumer Health Benefits Ass'n, 1193
– N.Y. managed care, new reform laws expand, 927; BNA Analysis, 1108
– Usual, customary and reasonable rates information disclosure to patients, Natl. Ass'n of Ins. Comm'rs hearing, 1173

CONSUMER SATISFACTION

– Medicare Advantage plans, CMS seeks to raise quality ratings, forum, 151
– Medigap, 88 percent of policyholders pleased, study, 701

CONTRACEPTION

– Mass. health reform law, agency approves subsidized Catholic hospital-affiliated plan affording family services, 315; hospital ends affiliation with insurer subsidizing coverage, 779

CONTRACTS AND CONTRACTORS

– BCBS

See generally BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Breach of contract

See BREACH OF CONTRACT

– Hospitals

See generally HOSPITALS

– State

See specific states

– Substance abuse, plan does not cover residential treatment costs at facility without contract (9th Cir.), 923

COPAYMENTS AND DEDUCTIBLES

– Credit for copayment discrepancy, plan beneficiary must exhaust administrative remedies before filing suit (N.D. Cal.), 1067
– Employee benefits, high-deductible plan patients more involved in care decisions, survey, 507
– High out-of-pocket expenses and treatment delays linked, study, 537
– HMOs, state regulation violated by charging copayment and percentage fee for same single service (W.D. Mo.), 706
– Incentive programs, key to health costs reduction, BNA Analysis, 542
– N.C. state health plan, smokers and overweight workers will pay more, 534
– Private insurance, 17 percent enrolled in high-deductible plans in 2007, report, 297

COST OF HEALTH CARE

– Cooperatives as possible solution to rising costs, critics and supporters continue debate, Special Report, 1163
– Copayments

See COPAYMENTS AND DEDUCTIBLES

– Discount cards and programs

See generally DISCOUNTS

– Drugs

See generally PRESCRIPTION DRUG PRICES

– Employee

See generally EMPLOYEE BENEFITS

– High costs of U.S. health care system, analysts discuss various factors, Special Report, 1079
– Hospitals

See generally HOSPITALS

– Increase likely absent reform, report, 617
– Long-term cost reduction, reform efforts unlikely to effect, CBO official says, hearing, 857
– MA

See generally MEDICARE ADVANTAGE (MA)

– Medical home pilot program, CIGNA partners with Tex. clinic, 1075
– Medicare

See generally MEDICARE

– Minimally invasive surgery, incentives key to reduction, BNA Analysis, 806
– Multiemployer health funds, Segal Co. offers tips on managing costs, 1106
– Out-of-pocket costs

See OUT-OF-POCKET EXPENSES

– Per capita claims, increases projected to be high but similar to 2009, forecast report, 1009
– Provider-specific information, Aetna expands website, 320
– Quality of care promotion

– – Streamlining administrative options, UnitedHealth says system could save $332 billion over decade, report, 805
– – UnitedHealth says federal government could save $540 billion over 10 years, report, 643

– Rates

See PREMIUMS AND RATES

– Real income growth and impact of spending among articles in health journal, 1076
– Spending

– – Average, 7.4-percent increase lowest in 5 years, report, 627
– – $2.4 trillion in 2008, CMS report, 210

– State issues

See specific states

– Transparency

See generally TRANSPARENCY

– Uninsured persons, online N.C. pilot project provides immediate price information for patients and physicians, 832
– Website allows Minn. residents to compare health care services, 1072

COVERAGE AND REIMBURSEMENT POLICIES

– Medical necessity

See generally MEDICALLY NECESSARY SERVICES

– Medicare

See generally MEDICARE

– Overweight infants, Rocky Mountain Health Plans of Grand Junction reverses policy of denying coverage, 2026

CRIMINAL PROSECUTION

– Computer theft of private data, 30,000 Kaiser HMO workers affected, 191
– Fraud

See generally FRAUD AND ABUSE

– Medical identity theft

See IDENTITY THEFT