Second Circuit: HHS Rule for Embedded Individual Out-of-Pocket Limits Does Not Apply to Pre-2016 Health Insurance Plans
Second Circuit: HHS Rule for Embedded Individual Out-of-Pocket Limits Does Not Apply to Pre-2016 Health Insurance Plans
In Fisher v. Aetna Life Ins. Co., No. 20-3148, __F.4th__, 2022 WL 1193999 (2d Cir. Apr. 22, 2022), the Second Circuit considered three separate but related appeals concerning Plaintiff-Appellant Jacqueline…
Fourth Circuit Affirms District Court’s Award of Coverage for Surgery Because Claim Not Handled in ‘Fair-Minded’ Manner
In Garner v. Cent. States, Se. & Sw. Areas Health & Welfare Fund Active Plan, No. 21-1602, __F.4th__, 2022 WL 1160386 (4th Cir. Apr. 20, 2022), the Fourth Circuit affirmed…
Ninth Circuit Revives Putative Class Action Against UnitedHealth Group for Practices Related to Substance Use Disorder Treatment
In Ryan S. v. UnitedHealth Group, Inc., No. 20-56310, 2022 WL 883743 (9th Cir. Mar. 24, 2022), Plaintiff-Appellant Ryan S. brought a putative class action under ERISA and the MHPAEA…
Ninth Circuit Reverses Class Win Against United Behavioral Health
In Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022), a stunningly brief unpublished memorandum, the Ninth Circuit reversed Magistrate Judge Joseph…
Fourth Circuit Revives Claims for Residential Treatment Based on Plan Administrator’s Failure to Produce Documents During Claim Review Process
In Wilson v. UnitedHealthcare Ins. Co., No. 20-2044, __F.4th__, 2022 WL 552028 (4th Cir. Feb. 24, 2022), the Fourth Circuit considered whether Defendant UnitedHealthcare Insurance Company abused its discretion in…
Eighth Circuit Upholds Insurer’s Right to Reimbursement of Medical Expenses Despite Its Failure to Pursue Its Claims in Subrogation
In Vercellino v. Optum Insight, Inc., No. 20-3524, __F.4th__, 2022 WL 433036 (8th Cir. Feb. 14, 2022), the Eighth Circuit Court of Appeals considered whether an ERISA health plan’s insurer…
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