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LexisNexis® Mealey's™ Managed Care Liability Legal News
Headline Managed Care Liability Legal News from LexisNexis®

• Plaintiff Partially Granted Summary Judgment In Copayment Dispute
  ST. LOUIS - In partially granting summary judgment in favor of a plaintiff in a copayment dispute, a Missouri federal judge on Sept. 24 held that a 50 percent copayment cap applies under Missouri regulations and that the cap applies at the point of services (Lisa M. Vermiglio v. Group Health Plan Inc., No. 07-282, E.D. Mo.; See 1/23/08, Page 4). Full story on lexis.com
• Judge Finds Exclusion In Policy Not Applicable; Summary Judgment Denied
  KANSAS CITY, Kan. - A Kansas federal judge on Sept. 10 denied an insurance company's motion for summary judgment in a case alleging wrongful termination of coverage, finding that a pre-existing condition clause did not apply to support the defendant's cancellation of an insurance policy after one of the insureds was diagnosed with cancer (Rodney Pratt, et al. v. American Heritage Life Insurance Co., et al., No. 07-4026, D. Kan.; 2008 U.S. Dist. LEXIS 69602; See 7/3/07, Page 13). Full story on lexis.com
• Judge Declines To Dismiss Trade Violation Claims; Some Claims Subject To Arbitration
  PHILADELPHIA - A Philadelphia federal judge on Sept. 22 declined to dismiss claims made by a Pennsylvania hospital against a New Jersey health insurance company for allegedly stopping payment for services and steering patients to New Jersey hospitals but held that several of the claims must be submitted to arbitration (The Children's Hospital of Philadelphia v. Horizon NJ Health, et al., No. 07-5061, E.D. Pa.; See 3/19/08, Page 8). Full story on lexis.com
• Judge Dismisses Claims Against 'Silent PPO,' Allows Amendments
  CHICAGO - An Illinois federal judge on Sept. 23 dismissed claims brought by a provider against an insurance company for allegedly taking preferred provider organization discounts it was not entitled to but gave the plaintiff the opportunity to amend two of her claims (Kathleen Roche, D.C., individually and on behalf of others similarly situated v. Liberty Mutual Managed Care Inc., et al., No. 07-331, S.D. Ill.; 2008 U.S. Dist. LEXIS 72309; See 7/16/08, Page 8). Full story on lexis.com
• New Jersey Judge Grants Motion To Remand Reimbursement Case
  NEWARK, N.J. - A New Jersey federal judge on Sept. 17 granted an ambulatory service provider's request to remand its reimbursement case to state court, saying that the defendant could not meet its burden of showing that removal was proper based on preemption under the Employee Retirement Income Security Act (North Jersey Center for Surgery v. Horizon Blue Cross Blue Shield of New Jersey Inc., No. 07-4812, D. N.J.; 2008 U.S. Dist. LEXIS 71231). Full story on lexis.com
• Reimbursement Dispute Remanded; ERISA Does Not Govern Claims
  SAN DIEGO - A California federal judge on Sept. 19 granted a hospital's request to remand its reimbursement dispute to state court, finding that the Employee Retirement Income Security Act did not govern the dispute (Pioneers Memorial Healthcare District v. Robert F. Kennedy Farm Workers Medical Plan, et al., No. 08-747; S.D. Calif.; 2008 U.S. Dist. LEXIS 72608). Full story on lexis.com
• Defendants Accused Of Wrongfully Denying Benefits Seek Dismissal
  NEWARK, N.J. - Defendants accused of wrongfully denying mental health benefits on Sept. 2 filed separate motions to dismiss, saying the court lacked jurisdiction to hear the claims (Dawn Beye, individually and on behalf of all others similarly situated v. Horizon Blue Cross Blue Shield of New Jersey Inc., No. 06-5337; Ronald Drazin, et al. v. Horizon Blue Cross Blue Shield of New Jersey, No. 06-6219, D.N.J.; See 8/20/08, Page 4). Full story on lexis.com
• Provider Of Specialized Drugs, Insurer Reach Agreement On Payment Of Claims
  Case name: New Life Home Care Inc., et al. v. Blue Cross Blue Shield of Michigan, et al.; See 8/7/08, Page 19 Full story on lexis.com
• Undisclosed Settlement TReached In Denial Of Benefits Case
  Case name: Cindy and Mark Raugh v. CHA HMO Inc. d/b/a CHA Health; See 7/16/08, Page 25 Case number: 07-298 Full story on lexis.com
• Blue Cross Granted Summary Judgment; Denial Of Benefits Affirmed
  BURLINGTON, Vt. - A Vermont federal judge on Sept. 24 granted summary judgment in favor of a health insurer, holding that its decision to deny benefits for a component for a power wheelchair that would aid standing was supported by a finding that the device was not medically necessary (Richard B. Durgin v. Blue Cross and Blue Shield of Vermont, No. 07-241, D. Vt.; 2008 U.S. Dist. LEXIS 73659).