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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 American Hospital Association has issued a Costs of Caring Report showing increased costs to hospitals and health systems coupled with inadequate payer reimbursement creating “an environment of financial uncertainty where many hospitals and health systems are operating with little or no margin.” Among the highlights of the Report are the following: Hospitals’ labor costs,

In a victory for providers, the Fifth Circuit Court of Appeals has affirmed the District Court opinion striking down the rules governing how payments for out-of-network payments should be determined in arbitrations under the No Surprises Act. Congress passed the No Surprises Act to prevent patients from being surprised by bills for out-of-network cost sharing

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

Lawyers at Whatley Kallas had the good fortune of working together with Ralph Knowles in a number of cases, and our former partner, Jack Drake, was Ralph’s partner for many years.  Ralph was justifiably recognized as a great lawyer and admitted to the Alabama Lawyer Hall of Fame.  One can read about some of Ralph’s

The United States Department of Labor has issued a final rule overturning a Trump Administration policy allowing some small businesses to use Association Health Plans to avoid providing patient protections required by the Affordable Care Act (“ACA”). The now overturned policy allowed certain groups of employers to form associations to offer health insurance coverage that