Earlier this month, United States Senators Kirsten Gillibrand and Lindsey Graham introduced bipartisan legislation that would prohibit employers from requiring workers who suffer sexual harassment to arbitrate their claims. 

As much of the nation eagerly anticipates a pending United States Supreme Court ruling regarding whether a collective action ban included in an employer’s arbitration agreement is lawful under the National Labor Relations Act, a Wisconsin federal court has decided to uphold a class arbitration award in a wage and hour case. 

Jeffrey W. Stempel, Doris S. and Theodore B. Lee Professor of Law at the University of Nevada, Las Vegas, William S. Boyd School of Law, has published “Notes from a Quiet Corner: User Concerns About Reinsurance Arbitration – And Attendant Lessons for Selection of Dispute Resolution Forums and Methods,” 9 Arbitration Law Review 93 (2017). 

The Texas A&M University School of Law has beefed up its ADR curriculum after welcoming Professor Nancy Welsh as Director of the Aggie Dispute Resolution Program this fall.

by Holly Hayes In June, we discussed the passage of Texas House Bill 2256, which provides a procedure for mediation of out-of-network health benefit claim disputes. Patients in Texas now have the option to mediate when they are ‘balance-billed’ by their insurance company for services provided by out-of-network facility-based physicians like radiologists, pathologists, neonatologists, and emergency room physicians. (post available here) In October, the Dallas Morning News reported on the practice of ‘balance billing.’ The article cited an example of a patient who went to an emergency room in Denton to receive treatment. The hospital was in his insurer’s network, but the emergency room physician was not. The patient was billed for the balance not paid by his insurer. (read more here) In November H.R. 3962, the “Affordable Health Care for America Act,” was introduced in the U.S. House. (bill status is here) In the definition of “cost sharing,” the bill specifically excludes “balance billing amounts for non-network providers” in out-of-pocket payments which are capped for an individual at $5,000 or $10,000 for a family. Balance billed amounts would not be included in the out-of-pocket caps. (read more here) According to the Wall Street Journal, while other states have addressed aspects of ‘balance billing,’ no other states appear to have included an option for patients to request mediation for resolution of ‘balance billing’ amounts. Some states have banned ‘balance billing’ of the patient altogether. In January, the California Supreme Court ruled that emergency-room patients can no longer be billed by hospitals and doctors for treatment that is not fully paid for by their health plans and that billing disputes must be resolved solely between providers and health plans. The California Department of Managed Health Care said that Connecticut, Alabama, and Pennsylvania have also banned ‘balance billing.’ (read more here) Technorati Tags: Healthcare, ADR, law, mediation Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at: holly@karlbayer.com.

By Holly Hayes As noted in a previous post (available here) Texas House Bill 2256, signed into law on June 19, 2009, provides a procedure for mediation of out-of-network health benefit claim disputes. The law gives patients the option to mediate when they are ‘balance-billed’ by their insurance company for services provided by out-of-network facility-based physicians like radiologists, pathologists, and neonatologists. ‘Balance billing’ occurs when a physician bills a patient for the difference between what the physician charges for a service and what an insurer pays the physician for that service. When a physician is not in-network for an insurer, there is no contracted payment rate that the physician has agreed to accept from the insurer so the insurer can pay what is deemed appropriate and the patient is billed for the difference. At the federal level, H.R. 3962, the “Affordable Health Care for America Act” is currently being considered in Congress. The bill defines ‘cost sharing’ (see bottom of page 9) and specifically excludes “premiums, balance billing amounts for non-network providers, or spending for non-covered services.” Although the bill says that out-of-pocket payments are capped for an individual at $5,000 or $10,000 for a family, out-of-network balance billing amounts are not included in those caps. Find out more at the The Wall Street Journal Health Blog (here). Look for an analysis of how other states are approaching ‘balance billing’ in a future post. Technorati Tags: Healthcare, ADR, law, mediation Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at: holly@karlbayer.com.