| | | Chair's Column: Emerging Issues
by Andrew J. Demetriou, Fulbright & Jaworski LLP, Los Angeles, CA I hope that you're making plans to join fellow members of the Health Law Section at our 9th Annual Emerging Issues Conference in San Diego February 20-22--or better yet have already joined the growing list of registrants for this important conference. For those of us who have lived with EMI since its inception, the meeting will always enjoy a special place in our hearts. EMI was the brain child of our former Chair, and current Delegate to the House, Howard Wall, who saw a need for the Section to distinguish itself through the production of a high quality educational conference focusing on cutting edge developments in health law and policy. He had the foresight to suggest that the conference rotate between the East and the West in alternate years so that we could expose the Section's activities to lawyers in various states and thereby build membership. The success of EMI is a tribute to Howard's vision, as well as the insights and values brought to it by each succeeding Chair of the Section. MORE  |
| 'Physician Transparency' Movement Advances Thanks to New York Attorney General
by Alice L. King, Hogan & Hartson LLP, New York, NY New York Attorney General Andrew Cuomo has achieved the near impossible. Insurers, physicians, and consumer groups all agree that the "groundbreaking" agreement negotiated several weeks ago by Cuomo's office and several major health insurers is a significant step forward in the drive to give consumers more information about the quality of their doctors and the cost of the care they receive. It marked the first such settlement between a state regulator and an insurer. MORE |
| Legal Implications Of Creating Patient Cost-Sharing Parity By Out-Of-Network Providers
by Denise Webb Glass, Fulbright & Jaworski L.L.P., Dallas, Texas Increasingly, providers rely on participation in preferred provider plans to maintain patient volume. However, as providers have become more dependent on participating provider status, managed care plans have begun to limit provider participation in their networks to maintain cost efficiency. When a provider is out-of-network, the result for plan members who receive services from the provider is that they owe higher copayments, deductibles and other patient cost sharing amounts. Consequently, some out-of-network providers have begun to encourage patients to continue receiving services despite the provider's out-of-network status by waiving or reducing the increased portion of the copayment, coinsurance, or deductible amount attributable to the out-of-network services. Notably, this reduction or waiver is being given without regard to the patient's financial ability to pay in an attempt to create parity for the member so that the cost to the plan member is the same as if he or she had gone to an in-network provider (the "Practice"). But, providers who engage in this Practice risk being charged with violating state and federal laws and sued by managed care organizations ("MCOs"). MORE |
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| Managed Care & Insurance Interest Group The Managed Care & Insurance Interest Group focuses on such issues as federal and state regulation of HMOs and other managed care organizations. The IG is led by Chair Cindy M. Stamer, Glast, Phillips & Murray, PC, Dallas, TX and Vice Chairs Michelle Apodaca, Brown McCarroll LLP, Austin, TX; Denise Glass, Fulbright & Jaworski LLP, Dallas, TX; Gabriel Parra, Presbyterian Healthcare Services, Albuquerque, NM and Daniel K Settelmayer, Latham & Watkins LLP, Los Angeles, CA If you would like to join the Interest Group, continue by clicking the following link: Health Law Section IG Sign-up Form. |
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The opinions expressed are those of the authors and shall not be construed to represent the policies or positions of the ABA or the ABA Health Law Section.
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