Day: February 26, 2023

Blue Cross Tells Client To Stick It

Suit Against Anthem Exposes Conflict Over Health Claims Data

Article Referred By C. Smith, M.D.

An employee health plan sues its health insurance administrator for refusing to turn over claims data that would allow the employer to verify the accuracy of charges against its self-funded health insurance plan. Medical supply vendor Owens & Minor says Anthem Blue Cross and Blue Shield has refused to provide it with claims data since 2021 as required by federal law. Anthem says its claims data involves proprietary arrangements that it doesn’t want to make public. Several similar lawsuits have been settled out of court, with details hidden behind non-disclosure agreements.

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Aldeen’s Sunday Morning Bathroom Read

Doug Aldeen• ERISA Healthcare Attorney and General Counsel

The state of Connecticut plans to erase $2 billion in medical debt for its residents.
Caveat Emptor and Key Inquiries: 1) Determine the original price of the medical services and 2) How many individuals were otherwise eligible for financial assistance? Perhaps $20mm is still overpaying these hospitals…

“No one wakes up and says, ‘I want to go to the hospital,'” said Ayesha Clarke, interim director of the Hartford-based nonprofit Health Equity Solutions. “However, when it happens, seeking care should not result in a lifetime of financial hardship.

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Did You Read The Contract? Then Why Did You Sign It?

It’s been our experience over the years most Plan Sponsors never read their TPA administrative agreements. As an example, some years ago a client approved their ASO agreement without first allowing us to review it as was required under our management agreement. They screwed themselves and I had to tell them they screwed themselves. Sugar coating has never been our style.

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