Health Plan & Provider Report Index Summary

OBESITY

– Excess skin removal after gastric bypass surgery, coverage denial upheld as medically unnecessary (S.D. Ohio), 377

OFF-LABEL USE

– Compendia review, Part D coverage decision needs addressed, audio conference, 420
– Medicare physicians payment increase, Baucus (D-Mont) says June action possible on $15-$18 billion legislation, 519; Feinstein (D-Cal) urges expanded Part D coverage, 605

OHIO

– Discounts, prescription drug card, 499
– HMO enrollees, employer group plans dropped as Medicaid rose, report, 610
– Physicians, new insurer contract negotiations law, 374

ONCOLOGY

See CANCER

OREGON

– Consumer satisfaction, health insurance claims denials top complaint, report, 699
– Discount Prescription Drug Program, 2007 enrollment up, 60
– Hospital costs, 90 procedures on state Web site, 528
– Radiology services, antitrust suit by excluded providers properly dismissed (9th Cir.), 588

ORGAN TRANSPLANTS

– Part A benefits exhausted, Medigap must pay hospital for policy holder's kidney transplant (Wis. Ct. App.), 356

OUT-OF-NETWORK CARE

– ASCs, anti-assignment provision no bar to provider's ERISA claims (D.N.J.), 302
– Emergency services

– – Ill. Medicaid managed care, plan can pay providers state-set rate (Ill. App. Ct.), 588
– – Kaiser sued over reimbursement rates (Cal. Super. Ct.), 247

– HMOs, ERISA claim over daughter's bulimia treatment coverage reinstated (9th Cir.), 213
– Independent review, commissioner need not follow recommendation to cover multiple myeloma treatment (Mich.), 482
– Mental health parity, implementation requirement, study, 13
– Standing, benefits assignee provider may not sue plan to recover treatment costs (W.D. Mich.), 212
– Students, Aetna agrees to reimburse for improper claims processing, 732

OUT-OF-POCKET EXPENSES

– Chronic diseases, annual drug license fee payment proposed to cut costs, study, 124
– Financial burden increasing with stagnant incomes, study, 63
– Part D, 2006 tracking faulted, IG report, 9
– Wis. plans, estimates for members, 612

OUTCOMES

– Comparative effectiveness research linked to improvement, CBO report, 14

OVER-THE-COUNTER PRODUCTS

– Zyrtec version, BCBS of Mich. to pay, 177