Eleventh Circuit Upholds Insurer’s Denial of Nasal Surgery Coverage as Not Medically Necessary
Eleventh Circuit Upholds Insurer’s Denial of Nasal Surgery Coverage as Not Medically Necessary
In Gomez v. Neighborhood Health Partnership, Inc., No. 24-11898, 2025 WL 2658881 (11th Cir. Sept. 17, 2025), the Eleventh Circuit affirmed a district court decision granting summary judgment to Neighborhood…
Fifth Circuit Revives Emergency Physician Groups’ ERISA Claims Against Out-of-State Blue Cross Plans
In Angelina Emergency Medicine Associates PA v. Blue Cross and Blue Shield of Alabama, No. 24-10306, ---F.4th----, 2025 WL 2268126 (5th Cir. Aug. 8, 2025), a significant decision for out-of-network…
Sixth Circuit Rejects Tribe’s ERISA Fiduciary Breach Claims as Time-Barred in Longstanding Dispute with Blue Cross
In Grand Traverse Band of Ottawa & Chippewa Indians v. Blue Cross Blue Shield of Michigan, No. 24-1367, ---F.4th----, 2025 WL 2104569 (6th Cir. July 28, 2025) the Sixth Circuit…
Ninth Circuit Vacates Denial of ERISA Benefits, Faults Procedural Deficiencies in UnitedHealthcare’s Claims Process
In Solis v. T-Mobile US, Inc., et al., No. 24-2412, 2025 WL 1937089 (9th Cir. July 15, 2025), the Ninth Circuit vacated a district court ruling that upheld the denial…
Sixth Circuit Rejects Hospitals’ Attempt to Expand Insurers’ Payment Obligations for Emergency Care
In AMISUB (SFH), Inc. v. Cigna Health & Life Ins. Co., No. 23-5714, ---F.4th----, 2025 WL 1806073 (6th Cir. July 1, 2025), the Sixth Circuit affirmed the dismissal of a…
Ninth Circuit Affirms ERISA Violation for Mental Health Claim Denial but Orders Reconsideration, Not Benefits
In Oksana B. v. Premera Blue Cross, et al., No. 24-560, 2025 WL 1734443 (9th Cir. June 23, 2025), an unpublished memorandum decision, the Ninth Circuit addressed a dispute over…
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