A TALE OF TWO FIDUCIARIES

Eric and Denise Kinsinger sued Eric’s employer, SmartCore, LLC, because its health plan failed to cover Denise’s hysterectomy despite preauthorization from the plan’s TPA. In addition to suing the corporation, the Kinsingers named plan administrators Steven Matthew Good and William H. Winn, Jr., personally as defendants for their roles as fiduciaries. On August 26, 2019, [...]

By |2019-09-04T13:24:55-04:00September 4th, 2019|2019 News, Uncategorized|

The Camel’s Body is In the Tent

A bipartisan bill called the Lower Health Care Costs Act is under discussion in the Senate Health committee. It addresses surprise medical bills, high drug prices, and public health problems.  It would also improve transparency to ensure that pharmacy benefit managers pass along drug discounts to customers.  In addition, the bill aims to prevent certain [...]

By |2019-06-26T15:32:37-04:00June 12th, 2019|2019 News, News|

Bipartisan Support for New Attempts to Control Prescription Drug Costs

Lawmakers on both sides of the aisle are applauding two recent developments in the ever-raging battle to contain the cost of American healthcare. On May 8, 2019, the Department of Health and Human Services (HHS) announced a final rule from the Centers for Medicare & Medicaid Services (CMS) that will soon begin requiring pharmaceutical manufacturers [...]

By |2019-06-26T15:34:17-04:00May 20th, 2019|2019 News, News|

Telehealth – The New Frontier of US Healthcare

Telehealth, a form of “virtual healthcare” where diagnosis and treatment are delivered remotely through the use of technology (typically via telephone or video chat), is becoming an increasingly popular element of the US healthcare landscape. Employers and insurers are attracted to telehealth by its relatively low cost as compared to traditional healthcare. For patients, online [...]

By |2019-04-15T09:22:46-04:00April 15th, 2019|2019 News, News|

Association Health Plan (AHP) Provisions Ruled Illegal

AHPs were created in 2017 by President Donald J. Trump’s Executive Order, and the Department of Labor (DOL) expanded on them in 2018.  The goal was to promote healthcare choice and competition across the United States.  The changes allowed unrelated small businesses to join together to get better underwriting and avoid certain mandates. However, a [...]

By |2019-06-26T15:31:49-04:00April 4th, 2019|2019 News, News|

You Can’t Shop for Something if You Don’t Know the Cost

Should hospitals and other healthcare providers publicly disclose the secretly negotiated prices they charge insurance companies for their services?  Today’s complex arrangements, hidden charges, and lack of transparency make it hard to tell which hospitals and doctors are driving costs higher. Insurers and hospitals routinely enter into confidentiality agreements that make it possible for the [...]

By |2019-03-21T09:08:59-04:00March 21st, 2019|2019 News, News|

Dave & Buster’s Busted

The Affordable Care Act (“ACA”) requires larger employers (50 or more full-time equivalents) to offer “affordable” “minimum-value” health care to employees working 30 or more hours per week or face the possibility of significant penalties.  In response, some employers cut employee hours to avoid offering health insurance.  The recent class action settlement proposed by Dave [...]

By |2019-06-26T15:35:24-04:00February 27th, 2019|2019 News, News|

Employers Encouraged To Review Health Plan Administrators’ Payment Practices After Recent Court Decision

In Peterson v. UnitedHealth Group Inc., plaintiffs filed a class action lawsuit against United Healthcare claiming that its cross-plan offsetting practice violated ERISA.  This practice allows an insurer or third party administrator (TPA) to recover overpayments to a provider by offsetting future payments for claims related to different employers’ plans and participants. The claims can [...]

By |2019-01-28T13:40:02-04:00January 28th, 2019|2019 News, News|

Don’t Lament, “I Could Have Done More”

Employers are often surprised to learn they are liable for ERISA statutory penalties associated with participant document requests even though they have retained an insurance company or TPA to administer their ERISA welfare benefits plans. Generally, only the Plan Administrator, as defined by ERISA, can be penalized for failure to respond to document requests, and, almost [...]

By |2019-06-27T07:00:34-04:00January 1st, 2019|2019 News, News|