Blog/Newsroom

U.S. Supreme Court to Decide Whether Health Care Reform Law Will Stand

Earlier this week the Supreme Court got the ball rolling toward what is expected to be the final showdown on the federal health insurance reform law. The Court agreed to hear several issues that have been litigated in lower courts since the law was enacted. The Court set aside an unprecedented 5 and ½ hours …

Read More

Fifth Circuit Rejects Distinction Between Existence of Coverage and Extent of Coverage in ERISA Preemption Analysis

November 9, 2011—The United States Court of Appeals for the Fifth Circuit issued an opinion yesterday that assures healthcare provider’s viable state law claims against employee benefit plans will not be dismissed based on ERISA preemption. The decision does not signal a major change in the law, but corrects a common misapplication of existing law. …

Read More

COBRA Coverage

Existence of COBRA coverage, with all of its deadlines and mind-numbing rules, creates headaches for providers, but managed effectively, also provides reimbursement unavailable without the coverage. Plans required to offer COBRA also see it as a headache, but for the opposite reasons. Plans want to avoid extra reimbursement and they adroitly use the complex laws …

Read More

Medicare Secondary Payer

Despite the longstanding prohibition against such activity, Group Health Plan’s (GHPs) continue to search for ways to take Medicare into account, denying plan member’s benefits to which they are entitled and leaving the federal government to pay for treatment cost the GHPs are required to cover. The Gibson Firm has encountered two main trends in …

Read More

Repricers and “Cost Containment” Solutions

In 2010, we saw an explosion in the number of benefit plans employing repricers and ―cost containment‖ companies. Typically, these companies offer to review charges submitted by providers and reduce the charge to a “reasonable’ amount under the auspices of “usual and customary” reimbursement. In exchange, the repricer is usually paid a percentage of the …

Read More

Federal Health Insurance Reform

The Patient Protection and Affordable Care Act (PPACA) was enacted last year and created many reforms that have already taken effect: No pre-existing conditions for children Extension of dependent coverage for young adults Free preventative service benefits Abolishment of lifetime benefit caps Regulations on annual benefit caps Prohibition of coverage rescissions Expanded appeal procedures Additionally, …

Read More