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Category: Health Insurance

Your ERISA Watch – Blue Shield Must Face Lawsuit for Denied Proton Beam Radiation Therapy Claim Despite Paying Provider Directly

This week’s notable decision, Rois-Mendez v. California Physicians’ Service dba Blue Shield of California, Case No. 20-cv-02227, 2021 WL 242906 (N.D. Cal. Jan. 25, 2021), is a proton therapy cancer treatment denial case with a twist. Rois-Mendez was covered under…

Your ERISA Watch – Court Grants Catholic Church Permanent Injunction Regarding Coverage of Gender-Transition Procedures

This week’s notable decision is Religious Sisters of Mercy v. Azar, Case No. 3:16-cv-00386, __F.Supp.3d__, 2021 WL 191009 (D.N.D. Jan. 19, 2021). In these consolidated cases, a coalition of entities affiliated with the Catholic Church and the State of North…

Your ERISA Watch – Supreme Court Finds ERISA Does Not Preempt Arkansas State Law Regulating Pharmacy Benefit Managers

This week’s notable decision, Rutledge v. Pharm. Care Mgmt., Case No. 18-540, —S.Ct.—, 2020 WL 7250098 (U.S. Dec. 10, 2020), is a major win for consumers and pharmacies clearing the way for states to pass laws and implement regulations regulating…

Your ERISA Watch – Second Circuit Sides with Anthem and Express Scripts in Dispute Over the Setting of Prescription Drug Prices

In this week’s notable decision, Doe v. Express Scripts, Inc., No. 18-346, __F.App’x__, 2020 WL 7133860 (2d Cir. Dec. 7, 2020), the Second Circuit Court of Appeals further defines what it means to be an ERISA fiduciary. In short, a…

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