Author Archives: Admin

Law360 (January 20, 2023, 8:09 PM EST) — A Pennsylvania Blue Cross Blue Shield licensee asked a Pennsylvania federal judge to find that it is owed coverage from its excess errors and omissions insurer for antitrust litigation it is facing, part of which has been settled for $2.67 billion.

Capital BlueCross alleged in an amended suit Friday that Atlantic Specialty Insurance Co. refused to consent to the settlement agreement reached in 2020 by subscribers suing various BCBS units.

Capital BlueCross also alleged that Atlantic Specialty has declined coverage for ongoing litigation against BCBS units from health care providers.

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A major Texas health care network and a major Texas insurance company continue battling over a new contract. Failure to strike a deal by month’s end could mean fewer in-network options for thousands of Central Texans.

The combatants are Ascension Texas, parent of Ascension Providence in Waco, and Blue Cross and Blue Shield of Texas. At risk are patients who have coverage through Blue Cross and want or need treatment at an Ascension-branded hospital or surgery center in the state, including Waco.

Ascension Texas said in a statement it continues to negotiate contract terms “that will ensure BCBSTX policyholders maintain in-network access to Ascension Texas hospitals, physicians and hospital-based clinics including Dell Children’s Medical Center, and select joint venture facilities, including Ambulatory Surgery Centers.”

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Law360 (December 13, 2022, 6:33 PM EST) — Home Depot and others urged the Eleventh Circuit on Monday to upend an Alabama federal court’s approval of a $2.67 billion class settlement in multidistrict litigation against Blue Cross Blue Shield insurers, decrying the deal as favoring some employers and claimants over others and “immunizing horizontal restraints of competition.”

Each of the four separate briefs, in separate appeals moving forward together, took issue with a different aspect of the settlement resolving claims from individual and corporate insurance subscribers (but not health care providers) that comes with $626.6 million in attorney fees and an additional $40.9 million in costs for class counsel from Boies Schiller Flexner LLP, Hausfeld LLP and other firms.

Home Depot argued that the deal doesn’t adequately correct for allegedly anti-competitive abuses centered around policies that carve up parts of the United States between individual members of the BCBS network.

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By: Renee Cooper

12/2/2022

SPRINGFIELD, Ill. (WCIA) — A year after the largest health insurer in the state kicked Springfield Clinic’s 650 providers out of network, the clinic is launching its own health plan.

Blue Cross Blue Shield of Illinois broke up a 30-year relationship between the go-to network of capital city specialists, and as Target 3 reporters revealed, that break up left at least 55,000 patients without their doctors or with staggering bills.

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By: Samuel Hardiman

Memphis Commercial Appeal

11/25/22

The City of Memphis’ Human Resources Department told employees Friday that ongoing negotiations between Methodist Healthcare and insurer Blue Cross Blue Shield could result in the city’s employees losing access to some Methodist services as in-network.

Alex Smith, the city’s human resources chief, sent an email Friday morning that the negotiations between Methodist and Blue Cross Blue Shield over fees the insurer pays the hospital system for hospital and outpatient facilities. The lack of agreement, she warned, could impact the 14,000 people who are covered under two city plans.

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By: Sylvia Taylor

Sylvia Taylor is a law student at Mississippi College School of Law

I am writing to highlight and expand on the concerns raised in the WLBT article: “Blue Cross Blue Shield subscriber needing surgery is caught in the middle of the battle with UMMC”.

The article describes a Mississippi citizen suffering from the unsettled dispute between UMMC and Blue Cross Blue Shield; however, this is just one of many Mississippians affected by this issue. The longer this issue drags on, the longer Mississippians will be used as pawns in a game.

Blue Cross Blue Shield is one of the largest health care insurers in Mississippi. Health insurance prices are astronomical, especially when purchased through a private insurance company.

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by: Renée Cooper

Posted: Nov 4, 2022 / 11:36 AM CDT

Updated: Nov 4, 2022 / 11:36 AM CDT

SPRINGFIELD, Ill. (WCIA) — A year after Blue Cross Blue Shield of Illinois (BCBSIL) kicked Springfield Clinic, along with its 450 doctors and 200 advanced practice nurses, out of network, a top executive revealed that the clinic is “not optimistic about an agreement.”

In response to an update request from WCIA 3 Thursday, Chief Financial Officer Chase Hammon said Springfield Clinic is “disappointed” that efforts to restore a previously decades-long relationship with the largest insurer in Illinois “have not been more fruitful.”

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Law360 (October 18, 2022, 2:01 PM EDT) — Blue Shield of California reached a settlement in California federal court with Intact Insurance unit Homeland Insurance Co. of New York after it alleged Homeland failed to defend underlying claims that Blue Shield did not adequately reimburse hospitals for emergency services.

In a conditional dismissal order filed Monday, U.S. Magistrate Judge Sallie Kim gave Blue Shield and Homeland a 90-day window to notify the court if the settlement is not consummated before the case terminates for good.

Representatives of Blue Shield and Homeland did not immediately respond to requests for comment Tuesday.

Blue Shield moved for partial summary judgment in September, saying it incurred more than $10.1 million in defense costs across five lawsuits filed by hospitals that are part of Prime Healthcare Services Inc. hospital system.
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By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

By Reed Abelson and Margot Sanger-Katz

New York Times

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

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By: John Tozzi

October 5, 2022 at 11:47 AM CDT

Health insurance companies are set to raise prices next year faster than medical costs are increasing, according to some Wall Street analysts, adding pressure on US employers already facing severe inflation.

Benefits brokers expect rate increases of 6% to 12%, according to a survey conducted by BofA Global Research. Increases for employers will be higher than usual as inflation and labor expenses get priced into insurance premiums, analysts wrote.

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