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Health Insurance

Building for Blue Cross Blue Shield of Minnesota

If a health insurance company believes it overpaid on previous benefits, can it reduce payments for current, unrelated benefits? The complaint for this class action says it can only if its plan authorizes it. The plan for Blue Cross Blue Shield of Minnesota (BCBSM) does not authorize it, the complaint says, and the reduced benefits paid are a violation of the Employee Retirement Income Security Act (ERISA). 

Washington Regional Medical Center Building

This class action takes on another practice of the convoluted US healthcare system in which injuries sustained in a car accident may not be paid for by the injured person’s medical insurance. The complaint claims that plaintiff Curtis Randolph was treated at Washington Regional Medical Center (WRMC), a hospital within his insurer’s network, but that the hospital did not go to the insurer for reimbursement but instead pursued Randolph, sought funds from his auto insurer, and filed a lien filed on his potential personal injury recovery from the accident. 

Patient Lying on Gurney, Being Wheeled Through Hospital

Have you been treated at an in-network hospital or emergency room that accepts your insurance, only to receive a surprise bill from out-of-network personnel or services? Have you presented your insurance card, paid your deductible, coinsurance or copayment, and then still received a bill for thousands of dollars that you had no idea you would owe? 

Opioid Pills in Different Colors

The complaint for this class action begins by pointing out that, since 1999, there have been more than 183,000 opioid-related deaths in the US, or more than three times the number of US soldier who died in the Vietnam War. Its primary allegation is that the manufacturers and distributors of opioids have violated the Racketeering Influenced and Corrupt Organizations (RICO) Act and driven up the price of health insurance in Pennsylvania.

Health Net Logo

Plaintiff Kathleen Steinley’s family was insured with Health Net, Inc. But when she had to find a behavioral health and substance use disorder (BH/SUD) facility to treat her son upon his release from an acute psychiatric facility, she was unable to find one that would or could work with her insurance. The complaint for this class action claims that Health Net, Inc. misrepresented the availability of in-network providers and drove away out-of-network providers by refusing to pay them. 

Stages of Cirrhosis with Hepatitis C

How would you feel if you developed an often-fatal liver disease? Now imagine that a cure became available—but your insurer refused to pay for it until the damage to your liver was irreparable? That’s the case with new hepatitis C drugs and Centene Corporation, says the complaint for this class action. The company’s health insurance subsidiaries maintains fibrosis restrictions that the complaint says make no sense in medical terms. 

Sign for Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan has agreed to pay out nearly $30 million to settle a class action alleging that it had “most favored nation” clauses in its contracts with 70 general acute care hospitals in Michigan. According to the complaint, these clauses violated antitrust laws and inflated the price of health care.

Health Net Logo

This settlement resolves a class action dispute concerning the providers for Health Net’s individual and family Preferred Provider Organization (PPO) plans. The complaint alleges that Health Net made misrepresentation and omissions about the providers included in its networks. The company’s HMO plans, EPO plans, HSP plans, and employer-provided plans are not included in this settlement. 

Oxford Logo

The complaint for this class action claims that Oxford Health Insurance, Inc. (OHI) arranged with pharmacies to overcharge patients for prescription drugs and return the overcharges as “clawbacks” to Oxford, in violations of the terms of their health insurance plans. According to the complaint, the insurer’s actions violate the Employee Retirement Income Security Act (ERISA) and the Racketeering Influenced and Corrupt Organizations Act (RICO).

Neurodevelopment Therapy Exercise

According to the complaint, three-year-old FA has autism spectrum disorder (ASD) and needs Neurodevelopmental Therapy (NDT) and Applied Behavior Analysis (ABA) therapy. Unfortunately, the complaint alleges that the health plan he’s on covers only speech, occupational, and physical therapy for “non-chronic conditions, and acute illnesses and injuries” but does not cover those same services for developmental disabilities. This, the complaint alleges, is a violation of federal ERISA, the Affordable Care Act, and the Mental Health Parity Act, which requires that limitations on services to treat mental health conditions are “no more restrictive” than those applied to medical and surgical benefits.

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