Articles Posted in Insurance Claims

At issue in this South Carolina Supreme Court case was whether the medical malpractice statute of repose applied to indemnify the claim of Columbia/CSA-HS Greater Columbia Healthcare System — also known as Providence Hospital. The trial court in the Court of Appeals in South Carolina held that it does and thus barred the indemnity action brought by Providence Hospital. Because the statute of repose barred the indemnify action brought by the Providence Hospital, the Supreme Court of South Carolina affirmed the lower court’s and the appellate court’s decision.

In 1997, Dr. Michael Hayes and Dr. Michael Taillon were working as emergency room physicians at Providence Hospital as independent contractors. Arthur Sharpe came to Providence Hospital in the emergency room on the same date. He was complaining of chest pain. Drs. Hayes and Taillon evaluated Sharpe and diagnosed him as suffering from gastric reflux. Sharpe was then discharged from the hospital; in fact, he had actually suffered a heart attack. That heart attack was determined a few days later when he went to seek other medical care.

Because of the misdiagnosis, on May 25, 1999, Sharpe and his wife filed a medical malpractice and loss of consortium suit against Providence Hospital and Dr. Hayes. The Sharpes did not name Dr. Taillon as a defendant. Providence Hospital settled with the Sharpes on June 10, 2004.

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A lawsuit has been filed accusing IU Health of over-billing uninsured patients more for treatment than insured patients. This case has drawn a lot of attention. The matter was argued recently before the Indiana Supreme Court.

The case involves a 2010 lawsuit filed by two uninsured patients. The patients accused IU Health of over-billing them.

Although the original lawsuit for the over-billing was small, the consequences are enormous. Should the Indiana Supreme Court rule favorably, it would allow other patients to sue for hospital over-billings as far back as ten years. If the plaintiffs win the appeal, the case against IU Health could be converted to a class action.

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H.R. 3962, also referred to as the Health Care Reform Bill, promises “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” However, at 2,000 pages, the Health Care Reform Bill is a very lengthy document. Over the next five to ten years the Health Care Reform Bill will change the way Americans receive healthcare so it is important for all U.S. and Illinois residents to understand this bill.

This post will summarize the key issues involved in the Health Care Reform Bill rather than how the Healthcare Reform Act impacts Illinois residents. Basically, the Health Care Reform Bill deals with the issues of community rating in health insurance markets, employer mandates to offer health insurance, imposing a tax on “Cadillac” health insurance plans, and health insurance market competition.

The purpose of establishing community rating in health insurance markets is so that people with pre-existing conditions can gain access to affordable health insurance. Currently these people, who some would argue are the ones who need health insurance the most, are subject to higher rates and premiums on health insurance. These increased premiums were imposed by health insurance companies based on the logic that people with pre-existing conditions are more likely to see doctors than those without. Under a community rating plan, insurance companies would not be prohibited from charging higher health insurance premiums for people with pre-existing conditions and would be required to provide insurance to anyone who desires it.

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Yesterday, President Obama signed into law the house bill overhauling the United States’ healthcare system. Illinois’ Director of the State’s Department of Insurance will be at the center of overseeing changes that will affect Illinois citizens through the new bill, most of which involve insurance premium rates and eligibility.

One of the first changes that will affect Illinois residents is that the U.S. Department of Health and Human Services now has the ability to review and challenge any unreasonable health insurance rate increase. For example, the insurance hikes like those proposed by Anthem BlueCross in California this past February of rate increase of up to 39% would definitely raise a red flag under the new Healthcare Reform Act.

While Illinois did require insurance companies to report any increases to premiums within the local market, the Illinois Department of Insurance did not have the authority to approve or deny rate changes. Likewise, in small-employer markets the Department of Insurance did not have any authority to authorize rate changes, nor was it automatically given any information about rate increases or premiums charged to individual companies. But now, with the new healthcare laws, Illinois’ Department of Insurance will receive reports on rate increases and promises to examine and challenge any unreasonable insurance rate increase.

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