Insurers Send Payments Directly to Patients Depriving Providers of Reimbursement for Services
America’s healthcare system is complex. Unlike single-payer systems that exist in virtually all other industrialized countries, the U.S. relies on private health insurers to cover healthcare costs, many of which are for-profit companies. The way health insurance typically works in the U.S. is that when a patient sees a doctor or goes to the hospital […]
Insurer’s Exclusion for Outdoor Mental Health Programs Rejected
One of the hottest current topics in Employee Retirement Income Security Act litigation concerns medical insurance coverage for residential treatment of behavioral health disorders. A recent Utah federal court ruling, Michael D. and Madeline D. v. Anthem Health Plans of Kentucky Inc., 2019 WL 586673 (D. Utah, Feb. 13, 2019), is a prime example. The […]
The 5th Circuit Finally Gets De Novo Review Right (Somewhat)
In Ariana M v. Humana Health Plan of Texas, Inc., 2018 WL 1096980 (5th Cir. March 1, 2018), a divided Fifth Circuit issued an en banc ruling that finally overturned Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991) and concurred with every other Circuit that Firestone Tire & Rubber Co. v. […]
HB 1332 provides hope for eating disorders. Contact Governor Rauner to show your support
Individuals who suffer from eating disorders often run into difficulties securing coverage from their health insurers for treatment, especially for residential care. Last year, ERISA lawyer Mark DeBofsky of DeBofsky Law contacted Illinois State Representative Laura Fine and Illinois State Senator Julie Morrison with an idea to amend the Illinois Insurance Code to provide health […]
Case Guidelines not Meant as Rigid formula that Dictates Outcome
A recent ruling from the 1st U.S. Circuit Court of Appeals upheld an insurance company’s denial of health-care benefits for psychiatric treatment. Although the underlying facts are compelling, the most interesting aspect of the ruling was the court’s discussion of civil procedure and judicial standards of review under the Employee Retirement Income Security Act.