Over fifty cases across the country have challenged regulations promulgated under the Patient Protection and Affordable Care Act (“PPACA” or “Obamacare”) that require employer group health insurance plans to provide coverage for contraception, sterilization and related counseling (the “HHS Mandate”). Suits have been filed by religiously-affiliated organizations as well as private business owners, asserting that… Continue Reading
Unexpected bills to patients for out-of-network medical care have been a problem for years. Patients, their providers – both in and out-of-network – and the insurance carriers (the “payors”) have likely been involved at one time or another in the sometimes messy situation triggered by an out-of-network provider submitting a claim for charges. Payors have been… Continue Reading
The U.S. Department of Health and Human Services (HHS) has issued a final rule stating the future health insurance exchange (“Exchange”) and insurance issuer standards related to coverage of essential health benefits (EHB) and actuarial value. The final rule further establishes a timeline for when qualified health plans (QHPs) should be accredited in federally facilitated… Continue Reading
As Chris Kutner explained in his January 4, 2013 post, the Patient Protection and Affordable Care Act of 2010 (“PPACA” or “Obama Care”) requires, beginning in 2014, that employers with 50 or more full-time employees (“large employers”) offer “affordable” health insurance to their employees. Failure to do so will subject the employer to penalties. Recently published… Continue Reading
The Patient Protection and Affordable Care Act of 2010 (“PPACA” or “Obama Care”) requires, beginning in 2014, that employers with 50 or more full-time employees (“large employers”) offer “affordable” health insurance to its employees. Failure to do so will subject the employer to penalties. Future blog postings will address the coverage requirements and penalties under PPACA,… Continue Reading
In this election season, both presidential candidates offer plans to deal with the rising cost of providing health care services, the President’s “Obamacare” by increasing the number of insured individuals through Health Insurance Exchanges, and reducing costs for a continuum of services through Accountable Care Organizations; and Governor Romney by a consumer-driven approach through Medicare vouchers,… Continue Reading
Historically, health care services have been paid for by health insurance companies which accept monthly premium payments from employer groups and individuals. The premium for defined health care services is due whether the insureds under the policy use the benefits or not. Built into the premiums are additional administrative costs including fees paid to insurance brokers and general… Continue Reading
In order for an accountable care organization to succeed, there must be a workable method for collaboration among the providers. How do providers of care effectively communicate amongst one other? What is the optimum means of memorializing a patient’s medical history and present health status so that all providers of care are basing their decisions… Continue Reading
Now that the Affordable Care Act has been upheld by the U.S. Supreme Court, the requirement to control costs is critical. One thing we can learn from the experience of near universal coverage in Massachusetts is that providing access to more citizens without containing costs is a recipe for disaster. In 2006 Massachusetts achieved coverage… Continue Reading
The United States Supreme Court has upheld the 2010 Patient Protection and Affordable Care Act’s individual mandate not because it is as an exercise of Congressional power under the Commerce Clause, but because the mandate is within Congress’s power to lay and collect taxes. On Medicaid expansion, the Court ruled that the Act violates the Constitution… Continue Reading
With a decision by the Supreme Court on the constitutionality of the Patient Protection and Affordable Care Act expected shortly, the New York Times has published a simple interactive tool examining the potential impact of the decision if the Court were to strike all, some, or none of the provisions of the law commonly knows as “Obamacare”.… Continue Reading
The U.S. Department of Health and Human Services (“HHS”) released a final rule concerning Health Insurance Exchanges (“HIE”) on March 12, 2012. The final rule will be published in the Federal Register on March 27, 2012. In late March, 2012, the U.S. Supreme Court will hear arguments concerning the constitutionality of the Patient Protection and… Continue Reading
A recent decision in the Supreme Court, Kings County, has confirmed that health care providers have a private cause of action under N.Y. Insurance Law § 3224-a (the “Prompt Pay Law”). In Maimonides Med. Ctr. v. First United Am. Life Ins. Co., 2012 NY Slip Op. 22039 (decided February 22, 2012), the Court determined that… Continue Reading
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