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Bad Faith Health Insurance Legal News Articles & Interviews

United Healthcare Faces Class Action Lawsuit For 'Arbitrary' Therapy Payment Policy

United Healthcare Faces Class Action Lawsuit For 'Arbitrary' Therapy Payment Policy November 12, 2018. By Jane Mundy.
Sacramento, CA: Workers in the U.S. who received psychotherapy through their employers’ plans with United Healthcare Insurance Co. and United Behavioral Health (UBH) in California have filed a proposed class action, claiming the insurers have violated mental health laws

Policy Holders Pay More

Read [ United Healthcare Faces Class Action Lawsuit For 'Arbitrary' Therapy Payment Policy ]

Is a Health Plan Liable for the Negligence of an Unqualified Claims Reviewer?

Is a Health Plan Liable for the Negligence of an Unqualified Claims Reviewer? October 23, 2018. By Anne Wallace.
Sherman, TX Johnson v. UnitedHealthcare raises more questions than it answers about how ERISA protects health plan participants who bring bad faith insurance lawsuits over denied medical claims. Stephen Johnson had more than his share of hardship. The law hasn’t helped him. But it’s a complicated story that will affect claimants and health insurers denying medical claims in California and throughout the country. So hang on.
Read [ Is a Health Plan Liable for the Negligence of an Unqualified Claims Reviewer? ]

Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit

Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit September 20, 2018. By Anne Wallace.
Wilmington, DE As amputees fight for insurance coverage for advanced, microprocessor- assisted prostheses, it can help to look at other insurance lawsuits that describe a similar pattern of claims denials.

LifeWatch Services v. Highmark is actually an antitrust lawsuit dealing with telemetry cardiac monitors. Nonetheless, a recent opinion in the Third Circuit, describes a pattern of denials that amputees seeking coverage for “smart prostheses” will find strikingly familiar. The heart monitors, like the microprocessor-powered feet and legs are rejected as “not medically necessary” or “investigational.” The denials, sometimes in exactly the same language, are consistent across the Blue Cross Blue Shield network of insurers. Why is this so?

LifeWatch offers two strategic thoughts for amputees fighting for insurance coverage:

Read [ Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit ]

Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics

Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics August 6, 2018. By Anne Wallace.
Washington, DC In July 2018, the American College of Emergency Physicians filed an insurance lawsuit against Anthem Blue Cross Blue Shield over the insurer’s new policy of denying emergency room coverage after the fact. As a subpart of the strategy, Anthem refuses claims for in-hospital CT scans and MRIs ordered in the course of emergency diagnosis and treatment. The lawsuit focuses on the harm the policy does to patients. But it also shines a light on the damage that Anthem’s plan does to hospitals and the wider healthcare system.
Read [ Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics ]


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