PPOs & Networks Archives - ERISA & Benefit Plans

:: PHCS Rate Schedule Challenged In New Managed Care Litigation

Roy Harmon 502(A)(1)(B) Claim for Benefits / PPOs & Networks March 9, 2021 March 9, 2021

Chaffin v. Humana (S.D. Tex.) challenges Humana’s alleged use of the “Prevailing Healthcare Charges System” to establish rates of reimbursement for out of network providers. The case is brought by members of Humana’s “National Point …

:: Fiduciary Duties Not Implicated In Managed Care Rate Negotiations

Thus, in a nutshell, Blue Cross lowered rates for its own subsidiary by effectively raising them for Flagstar and other self-insured plans. The letter agreements between Blue Cross and the hospitals spell out these facts …