/PRNewswire/ -- On December 9, 2009, the United States Court of Appeals, Tenth Circuit, affirmed the federal government's position that private insurance companies are "plans" and therefore subject to federal jurisdiction. (US vs. Frost)
Although other federal courts have held that contracts issued by insurance companies may be subject to federal jurisdiction under Title 18 Section 1347, US vs. Frost is the first case an insurance company itself has been held to be a "plan," because, as the government claimed in this case, all insurance companies are "plans." At trial and initially on appeal in this case, the government maintained the position that insurance contracts are "plans," but to avoid a constructive amendment, changed their theory claiming that all insurance companies are "plans" as a "matter of law" and the 10th Circuit agreed.
Ironically, the term "plan" was first adopted by ERISA in 1974. Although ERISA generally excluded insurance companies as "plans," the federal government now claims that health insurance companies are the private equivalent of Medicare and Medicaid which are "plans." Therefore, all insurance companies that make payments for the cost of medical services are "plans" under federal law. The 10th Circuit agreed and upheld the district court's finding that simply paying a medical claim qualifies an insurance company as a "plan."
Not only does this ruling open the door for the federal government to hold all insurance companies subject to ERISA, but it automatically and retroactively subjects all insurance companies to federal jurisdiction under Title 18, 669, 1035 and 1347 by qualifying them as "Health Care Benefit Programs" under 24(b).
If upheld by the Supreme Court, a quantum leap toward federal regulation of health insurance companies will be complete. Redcorn and Frost, the defendants in the case, stated they would ask the Tenth Circuit to reconsider the matter 'en banc' before they appeal to the Supreme Court.
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Showing posts with label contract. Show all posts
Showing posts with label contract. Show all posts
Monday, December 14, 2009
Saturday, October 31, 2009
Aetna Signs Agreement with WellStar Health System
(BUSINESS WIRE)--Aetna (NYSE: ΑET) and WellStar Health System of Marietta, Ga. announced today that they have reached agreement on a three-year contract that provides access for Aetna’s Medicare Advantage members to the hospital’s facilities and physicians.
Under this new agreement, Aetna Medicare Advantage plan members will be able to receive covered services, at in-network rates, from WellStar facilities in the greater Atlanta area. Earlier this year, Aetna and WellStar reached agreement on a contract that applied to members of Aetna’s commercial plans. Aetna members also will be able to continue receiving covered services from WellStar physicians.
“Aetna is very pleased to expand its relationship with WellStar,” said Ramzy Elgomayel, Aetna’s vice president of network operations for Georgia. “WellStar has provided excellent care to our commercial-plan members for several years, and we’re delighted to be able offer in-network access to their facilities and providers for our Medicare Advantage plan members.”
“The expansion of the Aetna contract to cover the Medicare Advantage members further solidifies our relationship,” said Barbara Corey, senior vice president of managed care for WellStar. “We look forward to providing exceptional health care services to these members.”
Aetna provides health benefits to approximately 600,000 members in Georgia. Those members have access to a network that includes 80 contracted hospitals and more than 9,500 primary care physicians and specialists.
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Under this new agreement, Aetna Medicare Advantage plan members will be able to receive covered services, at in-network rates, from WellStar facilities in the greater Atlanta area. Earlier this year, Aetna and WellStar reached agreement on a contract that applied to members of Aetna’s commercial plans. Aetna members also will be able to continue receiving covered services from WellStar physicians.
“Aetna is very pleased to expand its relationship with WellStar,” said Ramzy Elgomayel, Aetna’s vice president of network operations for Georgia. “WellStar has provided excellent care to our commercial-plan members for several years, and we’re delighted to be able offer in-network access to their facilities and providers for our Medicare Advantage plan members.”
“The expansion of the Aetna contract to cover the Medicare Advantage members further solidifies our relationship,” said Barbara Corey, senior vice president of managed care for WellStar. “We look forward to providing exceptional health care services to these members.”
Aetna provides health benefits to approximately 600,000 members in Georgia. Those members have access to a network that includes 80 contracted hospitals and more than 9,500 primary care physicians and specialists.
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Tuesday, August 25, 2009
Aetna and WellStar Renew Agreement
(BUSINESS WIRE)--Aetna (NYSE: AET) and WellStar Health System in Marietta, Ga., announced August 24 they have reached an agreement on a three-year contract renewal.
Under this new agreement, Aetna members will continue to receive covered services, at in-network rates, from WellStar facilities in the greater Atlanta area. Aetna members also will be able to continue receiving covered services from WellStar physicians.
“Aetna is happy to announce this renewal” said Ramzy Elgomayel, Aetna’s vice president of network management for the Atlanta area. “WellStar Health System has provided valued care and services to our commercial-plan members.”
"WellStar is pleased to reach a new three-year agreement with Aetna. We look forward to seamlessly continuing the long standing relationship that we have had with Aetna. As a not-for-profit organization, and one of the top integrated health systems in the country, WellStar is committed to meeting the ongoing health care needs of our community and will continue to invest in and deliver high quality health care services," said Barbara Corey, senior vice president of managed care.
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Under this new agreement, Aetna members will continue to receive covered services, at in-network rates, from WellStar facilities in the greater Atlanta area. Aetna members also will be able to continue receiving covered services from WellStar physicians.
“Aetna is happy to announce this renewal” said Ramzy Elgomayel, Aetna’s vice president of network management for the Atlanta area. “WellStar Health System has provided valued care and services to our commercial-plan members.”
"WellStar is pleased to reach a new three-year agreement with Aetna. We look forward to seamlessly continuing the long standing relationship that we have had with Aetna. As a not-for-profit organization, and one of the top integrated health systems in the country, WellStar is committed to meeting the ongoing health care needs of our community and will continue to invest in and deliver high quality health care services," said Barbara Corey, senior vice president of managed care.
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Thursday, May 21, 2009
Blue Cross and Blue Shield of Georgia and Piedmont Healthcare Announce Contract Renewal
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) and Piedmont Healthcare announced today that they have reached agreement on a three-year contract, effective August 1, 2009.
Under the agreement, BCBSGA HMO/POS and PPO members can continue to access Piedmont Healthcare as an in-network provider, including services from Piedmont Clinic physicians, Piedmont Hospital in Atlanta, Piedmont Fayette Hospital in Fayetteville, Piedmont Mountainside Hospital in Jasper, and Piedmont Newnan Hospital in Newnan.
"We are pleased to continue our relationship with Piedmont Healthcare," said Amy Cheslock, vice president of health services, BCBSGA. "As the state's largest health benefits provider, this new contract allows us to continue offering our members a wide range of choices and continued access to affordable, quality health care."
"We are pleased to renew our participation in the BCBSGA provider network that serves so many of our patients," said Gregory A. Hurst, executive vice president and chief operating officer for Piedmont Healthcare. "Piedmont has a long-standing commitment to the residents of Georgia and the communities we serve. This agreement ensures that BCBSGA members will continue to have access to the highest quality healthcare and the physicians and hospitals they have come to trust."
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Under the agreement, BCBSGA HMO/POS and PPO members can continue to access Piedmont Healthcare as an in-network provider, including services from Piedmont Clinic physicians, Piedmont Hospital in Atlanta, Piedmont Fayette Hospital in Fayetteville, Piedmont Mountainside Hospital in Jasper, and Piedmont Newnan Hospital in Newnan.
"We are pleased to continue our relationship with Piedmont Healthcare," said Amy Cheslock, vice president of health services, BCBSGA. "As the state's largest health benefits provider, this new contract allows us to continue offering our members a wide range of choices and continued access to affordable, quality health care."
"We are pleased to renew our participation in the BCBSGA provider network that serves so many of our patients," said Gregory A. Hurst, executive vice president and chief operating officer for Piedmont Healthcare. "Piedmont has a long-standing commitment to the residents of Georgia and the communities we serve. This agreement ensures that BCBSGA members will continue to have access to the highest quality healthcare and the physicians and hospitals they have come to trust."
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