Health Insurer Fined For Violating Independent Review Rules

Washington's insurance commissioner recently announced a $100,000 fine in response to a consumer complaint that Kaiser Foundation Health Plan, an HMO, ignored consumers' rights in the health claims appeal process.  The commissioner found that Kaiser failed to follow several rules related to appeals of health insurance claims to an Independent Review Organization ("IRO"). At issue …

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The Fine Print Matters In Insurance Coverage Disputes

Many insurance disputes revolve around the fine print of the policy.  Unfortunately, the policy's specific language may define important terms differently from what the insured understood or was led to believe.  This was the case in the Seventh Circuit Court of Appeals' recent decision in Fiorentini v. Paul Revere Life Insurance Company. In Fiorentini, the …

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Pet Insurance: Read The Fine Print

Great Danes might be the best dogs - they're calm, require relatively little exercise and space, and are super affectionate towards their human family.  Unlike a lot of needier breeds who need constant activity, Danes reputedly just want to chill with you on the sofa. The problem with Great Danes is they're prone to significant, …

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The Moral High Ground Is Crucial In Insurance Disputes, Confirms Ninth Circuit

In any lawsuit, but particularly an insurance dispute, it's important to have the "moral high ground."  In an insurance case, this means cooperating with the insurer and responding to the insurer's reasonable requests for information.  Even where the insured is in the right, insurers often seize on the insured's failure to provide information about their …

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Unfair Health Insurance Billing Practices Highlighted in NPR Report

An NPR report from earlier this spring highlights many of the disputes individuals often have with their health insurance.  The article highlights one person's experience getting a $70,000 bill for a single surgery despite the hospital being "in network" with his insurer.  Both Medicare and medical billing nonprofits estimate the cost of the procedure at …

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ERISA Plan Cannot Recover Overpayments Resulting From The Plan’s Own Mistake

Most employee benefit plans (e.g., employer-sponsored health or disability insurance) allow the plan to recover excess overpayments it provides the insured.  This typically occurs where the plan provides benefits that are duplicated by another source of funding.  For instance, most long-term disability plans provide that benefit payments are offset by amounts the insured receives from …

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Health Plans Can’t Discriminate Against Mental Health Treatment Says Ninth Circuit

Among the challenges of a mental health condition is the difficulty persuading health insurers to cover treatment.  Mental health conditions can be difficult to objectively diagnose and can require lengthy and expensive treatment often with little prospect of a conventional "cure."  Hence, health plans have a powerful incentive to minimize coverage for mental health conditions …

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