Suzanne York

The Centers for Medicare & Medicaid Services has published rules governing Medicare Advantage for the 2026 contract year, which would add significant protections for enrollees and providers. Among the most significant provisions, the rules would: Tighten prior authorization requirements “to remove unnecessary barriers to care stemming from the use of inappropriate prior authorization” by adding […]

Judge Proctor has set the Preliminary Approval Hearing on the Provider Settlement in the Blue Cross Blue Shield Antitrust Litigation for November 14, 2024, at 9:30 a.m. in Birmingham, Alabama.  A copy of Judge Proctor’s Order can be found here. Up to date information on the settlement may also be found at www.whatleykallas.com/bcbs-settlement.

FOR IMMEDIATE RELEASE: October 14, 2024 BIRMINGHAM, AL – Today a monumental settlement was announced by Whatley Kallas, LLP, Co-Lead Counsel, in a long-running antitrust lawsuit filed on behalf of healthcare providers across the nation. The settlement with all the Blue Cross and Blue Shield entities in the country, as well as the Blue Cross

In a detailed opinion grounded in the text of ERISA and its implementing regulations, the Fifth Circuit held that UnitedHealthcare improperly denied mental health benefits for the insured’s minor child’s eating disorder treatment and that it failed to apply the correct reimbursement rate for the portion of the child’s treatment that it did cover. The

The Biden Administration has finalized its mental health parity rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (“the Act”).  The rules are designed to ensure that health insurance plans comply with the Act’s requirements to provide benefits for mental health and substance use disorder care on

KFF has issued a report entitled “Medicare Advantage in 2024: Enrollment Update and Key Trends.”  Some of the key findings in the report include: 54% of Medicare the Medicare eligible population is enrolled in a Medicare Advantage plan, amounting to 34 million people In seven states (Alabama, Connecticut, Michigan, Hawaii, Florida and Rhode Island) 60%

The Seniors’ Timely Access to Care Act, which is designed to address issues with Medicare Advantage plans’ use of prior authorization, has been reintroduced in Congress by a bipartisan group of legislators. The bill would establish an electronic standard to streamline approval of prior authorization requests by Medicare Advantage plans, reduce the amount of time

The United States Supreme Court has granted certiorari to hear a hospital’s challenge to how the Department of Health and Human Services calculates disproportionate share (“DSH”) payments for hospitals serving low-income patients.  The case, Advocate Christ Medical Center et al. v. Bercerra, involves the statutory interpretation of whether the phrase “entitled…to benefits” means the same

Whatley Kallas’s provider clients have been increasingly frustrated with Medicare Advantage plans’ inappropriate denials and reduced payment of claims and with the plans’ use of prior authorization to delay and deny care and we have been pursuing clams based upon those denials and reductions. Congress and the Centers for Medicare & Medicaid Services have also