Hospitals Say Some Medicare Advantage Plans Are Skirting CMS Rules
Groups lament stress to enrollees and billions in hospital losses from coverage delays, denials
Source: medpagetoday.com
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Denial of Mental Health Treatment Benefits Ruled Improper under Milliman Care Guidelines | Hinshaw & Culbertson - The LHD/ERISA Advisor
In Jessica U. v. Health Care Service Corp., a Montana district court held that an ERISA plan administrator improperly denied benefits for mental health residential treatment based solely on so-called "Milliman Care Guidelines" that were not included in the plan documents. The Milliman Care Guidelines ("MCG") are a set of health industry best practices, guidelines and diagnostic criteria published by MCG Health for providers and health plans. Although the MCG are widely used by health care professionals, the Jessica U. case illustrates that plan administrators must use caution when relying o...
Source: jdsupra.com