Managed Care Litigation Update Volume 9: May 31, 2014

• Jurisdiction: United States,Federal,Texas
• Publication year: 2014
• Citation: Vol. 9

Newsworthy

Aetna, United Healthcare, and Humana collaborate to form cost of care database, making claims payment data publically available. http://www.modernhealthcare.com/article/20140514/NEWS/305149981

Appellate Court affirms judgment against Blue Cross Blue Shield of Michigan for allegedly charging hidden fees to self insured client. http://www.detroitnews.com/article/20140514/BIZ/305140100.

Premera Blue Cross settlement calls for removal of restrictions on neurodevelopmental therapy for autism, $3.5 million to reimburse policyholders who paid out of pocket for therapy. http://seattletimes.com/html/localnews/2023644322_premerasettlementxml.html.

DHH complaint alleges four insurers discriminate against HIV patients with higher out of pocket drug costs. http://www.nytimes.com/2014/05/30/business/four-insurers-accused-of-discriminating-against-people-with-hiv.html?_r=0

Recently filed actions

Jeffrey B. and Jamison B. v. Anthem Blue Cross Life & Health Insurance Company, et al., U.S.D.C. N.D. Cal., Doc. No. 3:14-cv-02253-LB, (filed May 15, 2014). Removed action in which member seeks medical benefits for in-patient treatment received at mental health facility, contending improper denial on the basis of not medically necessary and treatment could be rendered in less restrictive setting.

Zoran Maric v. United Healthcare Services, Inc., U.S.D.C. S.D. Fla., Doc. No. 4:14-cv-10041-JEM, (filed May 16, 2014). Removed action in which dependent insured claims insurer has reimbursed hospital charges at a 50% level rather than 80%, thereby causing insured out of pocket to exceed policy limitations.

Dr. Joseph Tauro v. Blue Cross Blue Shield of Illinois and Johnson Controls, Inc., U.S.D.C. D. N.J., Doc. No. 3:14-cv-03184-FLW-DEA, (filed May 16, 2014). Removed action in which orthopedic surgeon, as alleged assignee, contends an underpayment was made by group health insurance plan for surgical services rendered to plan beneficiary.

Mary D. v. Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross Blue Shield, U.S.D.C. C.D. Cal., Doc. No. 2:14-cv-03863-GW-VBK, (filed May 20, 2014). Member seeks recovery for partial denial of mental health benefits for treatment at in-patient facility on grounds of medical necessity. Member alleges exhaustion of administrative remedies.

Sara Johnston v. Blue Cross Blue Shield of South Carolina, U.S.D.C. D. S.C., Doc. No. 4:14-cv-02028-RMG, (filed May 22, 2014). Removed action in which member contends insurer improperly denied...