On the inside, your arteries are getting clogged up with cholesteroland arterial plaque, while you may look okay on the outside.
Our body is our temple, and we need to take care of it to have a healthy life.
You know that a shockingover 65percentage of Americans are either obese or overweight, right? Generally, that’s insane! That said, that’s not a pretty sight! By the way, the greatest increase if filings appears in coverage disputes over residential treatment centers, from seven cases in 2014, 16 cases in 2015, to 47 in While the volume of case filings has increased, the source of the coverage dispute is fairly constant. Other cases involve instances where benefits was paid but the parties dispute over if the treatment is medically necessary beyond a certain date for which benefits was paid.
So there’s a parallel increase if filings alleging a violation of a federal or state mental health parity act, from 5 in 2014, to 11 in 2015, to 10 in 2016. Across all years, an ordinary theme in these cases is that the payor is discriminating, restricting, or otherwise improperly limiting mental health coverage, or placing an undue burden on access to coverage compared to other coverages for the underlying mental health benefit. That same trending of case data is an invaluable resource for patients and their counsel, and it may illustrate unequal application of an insurer’s plan benefits across members or a gap in benefits.
Trending case data is an invaluable resource for the legal departments of both payors and providers since litigation outcomes often directly affect plan underwriting or the availability of plan benefits.
The groupings of cases referenced in 2016, 2015, and 2014 do not necessarily fit neatly in one category to the exclusion of another.
I’m sure that the grouping of cases in the manner described is intended to illustrate really similar claims/themes being asserted in subsequent case filings. Aurora Bailey, et al. With all that said… Anthem Blue Cross Life and Health Insurance Company, et al, CA. Furthermore, a case might be categorized as both a putative class action and asserting a claim under a mental health parity act.
No. Certain events in ongoing cases are significant and warrant mention, while the emphasis of this article is trending data on new case filings. Cases can achieve resolution on balanced terms, while litigation over plan benefits is often contentious. Besides, a class action is a procedural device that can be both a sword and a shield, where resolution can be achieved, and benefits conveyed, on terms applicable to all affected health plan members. You should take this seriously. Payors frequently grapple with diagnoses and whether benefits are truly payable for the length of time sought by the provider and patient. Treatment for mental health conditions is expensive and many providers are out of network, thereby increasing the member’s selfpay obligation. So, given a greater awareness of mental health and a parent or guardian’s desire to obtain all necessary treatment, coupled with the mandate that mental health benefits be in parity with other policy benefits, the case volume has grown exponentially as courts have become the last step in the exhaustion of administrative remedies under the member’s health benefit plan.
See also Trends and Developments in Managed Care Litigation, published in the American Bar Association Health Law Section’s ABA Health eSource.
No.
October 29, This article is a follow up to last year’s article and specifically examines the increased number of filings seeking coverage for mental health benefits, as previously noted in the 2015 article. Nurit Zabludovsky United Healthcare Insurance Company, Cal. Now please pay attention. No. No. On p of that, Stephen Aetna Life Insurance Company, Cal, DDP CW,. Ariana Humana Health Plan of Texas, Inc, FMOMRW,. No. Managed Care Litigation is generally described as the tug of war among payors, providers, and patients. Usually, payors strive to adhere to their committed risk under their health plans, providers demand fair payment for services rendered, and patients simply need coverage for their medical expenses. Known the term Blue Cross Blue Shield Plans is intended to be a generic term that collectively represents the 36 independently operated Blue Cross and Blue Shield member companies.
Basically the terms Aetna, United Healthcare, Humana, and CIGNA are intended to be generic terms which identify with the four major health insurers. These entities collectively comprise the largest percentage of the hospital insurance plans and, concomitantly, represent the greatest collective percentage of disputes, while we’re talking about not a solitary health insurers. CIGNA was not named a defendant in most of the followed cases. Therefore, United was a named defendant in the largest number of case filings, followed by BCBS, Aetna, and Humana, as against the major insurers. Humana was not named a defendant in the majority of the followed cases. You can find some more info about this stuff on this site. Aetna was a named defendant in the largest number of case filings, followed by BCBS, United, and CIGNA, as against the major insurers.
I’m sure that the case data discussed above unquestionably reflects an explosive growth of cases seeking coverage for mental health benefits, and there’s no indication that the upward trajectory of case filings shouldn’t continue. Actual disposition of the cases, however, will remain a ‘factintensive’ inquiry under which the patient’s documented health needs are considered against plan benefits and whether those benefits comport with applicable mental health laws. No. Anthem Blue Cross Life and Health Insurance Company, et al, CA. No. Aurora Bailey, et al. Elena United Healthcare Insurance Company of NYC, NY, Doc, DPG,. Cara Z CIGNA Health and Life Insurance Company, FL. No. BCBS was a named defendant in the largest number of case filings, followed by Aetna, United, Humana, and CIGNA, as against the major insurers.