Health Benefits

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Why do health insurers deny claims?

When you are ill and a doctor recommends a course of treatment, you naturally assume that your health insurer will reimburse the cost.  That is not always the case, though, and it is not uncommon for benefits to be denied, especially if the costs are high.  Examples of types of claims that are frequently denied […]

Mental health coverage required under 2008 parity act

Increasing awareness of federal requirements for equal health insurance coverage of mental and physical conditions has led to a spate of litigation relating to health insurance denials. In Christine S. v. Blue Cross Blue Shield of New Mexico, 2019 WL 6974772 (D. Utah, Dec. 19, 2019), the issue was whether the plaintiff pleaded a valid […]

Courts continue to permit plaintiffs to plead simultaneous claims for benefits and breach of fiduciary duty under ERISA

Ever since the Supreme Court’s ruling in Varity Corp. v. Howe, 516 U.S. 489 (1996), courts have grappled with whether plaintiffs who file suit under the Employee Retirement Security Act of 1974 (“ERISA”) can plead simultaneous claims for benefits under § 502(a)(1)(B) along with claims for equitable relief under § 502(a)(3), and if so, under […]

Court questions insurer behavioral health treatment guidelines

Every major insurance company utilizes specific criteria to establish the appropriate medically necessary level of care during behavioral health treatment. But are such guidelines consistent with generally accepted standards for safe and effective treatment for psychiatric conditions? A recent federal court ruling from Connecticut, S.B. v. Oxford Health Insurance Inc., 2019 WL 5726901 (D. Conn., […]

Exercise your COBRA rights without getting snake-bitten

If you lose your health insurance as the result of job loss (resignation or termination), divorce, death of a spouse, or other qualifying event, the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) can provide a welcome bridge while you work to secure new health coverage. Yet there are many complexities and pitfalls to COBRA […]

Federal judge finds insurance giant UnitedHealth violated ERISA law

Approximately 50 percent of Americans receive health insurance through their employer, making most of those plans subject to the Employee Retirement Income Security Act of 1974 (“ERISA”). After passage of the Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”), the majority of health plans that cover mental health treatment, including large employer- sponsored […]