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Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes

Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes February 11, 2019. By Jane Mundy.
Scottsdale, AZ: Emergency room care in the US is the highest-priced care a patient can receive. Even a minor condition can set you back thousands of dollars, which in itself can cause health issues—financial problems are stressful. It can get worse: one patient dinged with outrageous emergency room overcharges later discovered that another patient with similar treatment paid a lot less.
Read [ Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes ]

LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard

LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard January 11, 2019. By Anne Wallace.
San Francisco, CA In one of the earliest decisions of 2019, the Ninth Circuit gave plaintiffs in long term denied disability lawsuits a new way to challenge benefit denial decisions. It may turn out to be significant.
Read [ LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard ]

ER Charges: Underserved and Over-Charged thanks to Upcoding

ER Charges: Underserved and Over-Charged thanks to Upcoding January 10, 2019. By Jane Mundy.
Los Angeles, CA: When a nine-year old accidentally had gasoline splashed in her eyes, her mother immediately drove her to the closest hospital emergency room. They were directed to the eyewash station but it was so dirty they couldn’t use it, so Brianna’s mom rinsed her daughter’s eyes at a regular sink. Turns out, they would have been better off using the gas station’s eyewash, which was free. The ER sink cost $1,400: the hospital charged $600 and the ER doctor fee was $800 (for walking into the room, saying Brianna needed an eyewash station and walking out). Upcoding has become common practice, resulting in emergency room overcharges and increased health costs for everyone.
Read [ ER Charges: Underserved and Over-Charged thanks to Upcoding ]

Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits

Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits January 8, 2019. By Anne Wallace.
Santa Ana, CA On November 20, 2018, the U.S. District Court for the Central District of California handed Pamela Fleming a resounding victory in her Unum disability insurance lawsuit. Unum had been paying her LTD benefits since 2005, after a serious and well-documented neck injury sustained in a car accident. A change in her treating physician and a brief surveillance video led the insurer to re-evaluate her claim and declare that she had recovered. The insurer terminated her benefits. Judge Cormac J. Carney was not impressed and reinstated her benefits due under the policy.
Read [ Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits ]

Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit

Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit December 17, 2018. By Anne Wallace.
Oklahoma City, OK In November 2018, a jury awarded nearly $25.6 million to the family of a Oranna Cunningham, a woman who was diagnosed with advanced nasopharyngeal cancer. Her insurer, Aetna, refused to cover the cost of the proton beam therapy recommended by her physician, claiming that it was “experimental or investigational.” After her death, her husband brought a bad faith insurance lawsuit.
Read [ Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit ]

Unum: the Gift of Giving and Taking Away

Unum: the Gift of Giving and Taking Away December 6, 2018. By Jane Mundy.
Chicago, IL: Yet another lawsuit was filed in November against First Unum for allegedly denying long-term disability benefits. In the same month, Unum announced to the media that it had donated $300,000 to a high-school girls’ leadership program.
Read [ Unum: the Gift of Giving and Taking Away ]

Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America

Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America November 16, 2018. By Anne Wallace.
Los Angeles, CA On September 14, 2018 Marisa Finnerty filed a long term denied disability lawsuit against the Life Insurance Company of North America (LINA), alleging that she had been wrongly denied benefits under her employer, Quest Diagnostics’, long term disability and group life insurance plans. Two things stand out about this lawsuit.
Read [ Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America ]

Unum’s Denial of Opioid Overdose Deaths

Unum’s Denial of Opioid Overdose Deaths November 15, 2018. By Jane Mundy.
New Orleans, LA: The giant insurance company Unum—also known as First Unum -- typically denies accidental death benefits (as do most other life insurance companies) by excluding in their policy coverage for deaths related to prescription overdose or for medical or surgical treatment of a sickness or disease. But Unum’s denial didn’t sway Judge Martin Feldman this past August.
Read [ Unum’s Denial of Opioid Overdose Deaths ]

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
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? ]

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