Ohio Court Finds Blue Cross Liable for Misleading Copayment Charges

Journal of Law, Medicine and Ethics 23 (4):409-410 (1995)
  Copy   BIBTEX

Abstract

On August 29, 1995, the United States District Court for the Northern District of Ohio ruled that certain practices of Blue Cross and Blue Shield of Ohio relating to the calculation of copayments on insurance claims violated provisions of ERISA, and thus BCBSO could be liable for unpaid benefits and breach of fiduciary duty ). According to BCBSO's Explanation of Benefits and Schedule of Benefits, beneficiaries were responsible for a 20 percent copayment for hospital charges, and the remaining 80 percent of the Provider's Reasonable Charges would be paid by BCBSO. BCBSO negotiated with the hospitals to create discount agreements whereby the actual charge to BCBSO was less than 80 percent of the total amount of the hospital's charges. By this arrangement, BCBSO paid less than 80 percent of what patients were billed; concurrently, patients paid more than 20 percent of the amount ultimately paid to hospitals for their services.

Links

PhilArchive



    Upload a copy of this work     Papers currently archived: 93,069

External links

Setup an account with your affiliations in order to access resources via your University's proxy server

Through your library

Similar books and articles

Tenth Circuit Upholds BC/BS's Anti-Assignment Provisions.K. M. - 1996 - Journal of Law, Medicine and Ethics 24 (1):72-73.
Supreme Court Limits Scope of ERISA Preemption.R. H. J. - 1995 - Journal of Law, Medicine and Ethics 23 (4):407-407.
Managed Care: Immunity for Peer Review Under HCQIA.Kaley Klanica - 2003 - Journal of Law, Medicine and Ethics 31 (1):160-161.
Managed Care: Immunity for Peer Review under HCQIA.Kaley Klanica - 2003 - Journal of Law, Medicine and Ethics 31 (1):160-161.
Herding Cats and Reforming the American Health Care System.Lance K. Stell - 1994 - Journal of Law, Medicine and Ethics 22 (1):72-82.

Analytics

Added to PP
2021-01-06

Downloads
8 (#1,344,496)

6 months
5 (#710,385)

Historical graph of downloads
How can I increase my downloads?

Citations of this work

No citations found.

Add more citations

References found in this work

No references found.

Add more references