Health Insurance

Centene Health Insurance Companies Refuse to Pay for Hepatitis C Treatment Class Action

How would you feel if you developed an often-fatal liver disease? Now imagine that a cure became available—but your insurer refused to pay for it until the damage to your liver was irreparable? That’s the case with new hepatitis C drugs and Centene Corporation, says the complaint for this class action. The company’s health insurance  Read more

Michigan Hospitals BCBSM Settlement

Blue Cross Blue Shield of Michigan has agreed to pay out nearly $30 million to settle a class action alleging that it had “most favored nation” clauses in its contracts with 70 general acute care hospitals in Michigan. According to the complaint, these clauses violated antitrust laws and inflated the price of health care. This  Read more

Health Net PPO Out-of-Network Provider Settlement

This settlement resolves a class action dispute concerning the providers for Health Net’s individual and family Preferred Provider Organization (PPO) plans. The complaint alleges that Health Net made misrepresentation and omissions about the providers included in its networks. The company’s HMO plans, EPO plans, HSP plans, and employer-provided plans are not included in this settlement.   Read more

Oxford Health Insurance Prescription Overcharges ERISA Class Action

The complaint for this class action claims that Oxford Health Insurance, Inc. (OHI) arranged with pharmacies to overcharge patients for prescription drugs and return the overcharges as “clawbacks” to Oxford, in violations of the terms of their health insurance plans. According to the complaint, the insurer’s actions violate the Employee Retirement Income Security Act (ERISA)  Read more

Neiman Marcus Health Plan Mental Health Parity ERISA Class Action

According to the complaint, three-year-old FA has autism spectrum disorder (ASD) and needs Neurodevelopmental Therapy (NDT) and Applied Behavior Analysis (ABA) therapy. Unfortunately, the complaint alleges that the health plan he’s on covers only speech, occupational, and physical therapy for “non-chronic conditions, and acute illnesses and injuries” but does not cover those same services for  Read more

Anthem Denial of Benefits for Microprocessor Controlled Prostheses Class Action

Defendant Anthem is one of the largest health insurers in the US, and defendant Anthem UM is its claims administrator. The two companies together develop Medical Policies and make decisions on which claims are approved and which are denied. One of their policies is the denial of claims for microprocessor-controlled lower limb prosthesis, the complaint  Read more

EpiPen Pharmacy Benefits ERISA Class Action

Pharmacy benefit managers (PBMs) OptumRX, ExpressScripts, and CVS Caremark have more than $200 billion per year in revenue and control almost 80% of the industry—and the complaint for this class action alleges that they do it by engaging in schemes for their own profit, violating their fiduciary duties to health plan consumers. Over time, the  Read more