Policyholders Can Sue for Health Insurer’s Refusal to Cover Proton Beam Therapy Cancer Treatment Says Washington Supreme Court

On October 3, 2019, the Washington Supreme Court decided Strauss v. Premera Blue Cross, holding the Strausses could sue Premera Blue Cross for denying coverage for Proton Beam Therapy to treat prostate cancer. Mr. Strauss had a Premera health insurance policy. The policy promised Premera would pay for “medically necessary” treatment. Mr. Strauss was diagnosed …

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Washing State’s “homegrown” health insurers credited with keeping rate increases low

Preliminary reports suggest Washington State's Affordable Care Act (a/k/a Obamacare) plans will see minimal rate increases in 2020. Washington State exchange plans are projected to see a 1% average rate increase, lower than almost half of other states in the U.S. Washington's Insurance Commissioner reportedly credited Washington-based health plans with the low increases. Washington-based insurers …

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Washington State Bans Surprise Medical Billing

We previously blogged about the push by Washington's Insurance Commissioner to ban so-called surprise medical billing, i.e., where an insured gets hit with a huge bill for medical treatment despite going to an in-network provider or seeking emergency care.  In those circumstances, the insurer claims the hospital's bill is too high and refuses to pay, …

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Washington State Enacts “Public Option” Health Insurance Plan

This week, Washington State passed a new law designed to offer consumers a so-called "pubic option" for buying health insurance.  The general idea is that the state will launch its own health insurance program to compete with the marketplace.  Unlike Medicare or Medicaid, anyone would have the option to purchase coverage through the "public option." …

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Aetna Settles Wrongful Depression Treatment Denial Allegations

On February 15, 2019, Aetna Inc. announced a settlement of allegations Aetna wrongfully denied mental health treatment.  The plaintiff and a group of Aetna insureds had filed a class action lawsuit under ERISA alleging Aetna wrongfully denied health insurance for a specific treatment for major depression called Transcranial Magnetic Stimulation ("TMS"). The lawsuit alleges Aetna …

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