Series of changes come after reports of Highmark premium notice errors Dozens of complaints have been registered with the Delaware Department of Insurance after Highmark Blue Cross Blue Shield processed hundreds of customer birthdates incorrectly, leading to notices of higher July 1 premiums for many Medicare Supplement participants, including those in the company’s Medigap Blue […]

Expanded federal subsidies keep consumer costs low; SEP sees success After two consecutive years of rate decreases, Highmark Blue Cross Blue Shield of Delaware, who offers the state’s Affordable Care Act (ACA) health plans, will increase base rates an average of 3% for the 2022 plan year. The announcement comes after extensive, in-depth independent actuarial […]

Navarro notes consumer reports spurred investigation Following a nearly years-long Market Conduct investigation, Insurance Commissioner Trinidad Navarro announced today penalties against Highmark totaling $363,570 relating to improper volunteer ambulance company claims reimbursement. Investigations began after reports were received that payments were going to residents rather than directly to volunteer ambulance companies for payment of services. […]

Unfair treatment of mental health conditions and other compliance issues uncovered, must be corrected. The Delaware Department of Insurance today announced the completion of its first follow-up Mental Health Parity and Addiction Equity Act (“Mental Health Parity”) examination, which also included reviews of complaint and grievance handling, policyholder services, claims, utilization review, and pharmacy review. […]

(United States Third Circuit) - Reinstated a medical device seller's claim that certain Blue Cross Blue Shield health insurance companies violated antitrust law by unreasonably restraining trade in the national market for outpatient cardiac monitors. The seller of a cardiac monitoring device contended that it was shut out of the market because the defendants conspired to deny insurance coverage for its product to shield themselves from patient demand for it. Holding that the seller stated a claim under section 1 of the Sherman Act, the Third Circuit reversed dismissal of the complaint and remanded for further proceedings.

(United States Third Circuit) - Reinstated a medical device seller's claim that certain Blue Cross Blue Shield health insurance companies violated antitrust law by unreasonably restraining trade in the national market for outpatient cardiac monitors. The seller of a cardiac monitoring device contended that it was shut out of the market because the defendants conspired to deny insurance coverage for its product to shield themselves from patient demand for it. Holding that the seller stated a claim under section 1 of the Sherman Act, the Third Circuit reversed dismissal of the complaint and remanded for further proceedings.

(United States Third Circuit) - Reinstated a medical device seller's claim that certain Blue Cross Blue Shield health insurance companies violated antitrust law by unreasonably restraining trade in the national market for outpatient cardiac monitors. The seller of a cardiac monitoring device contended that it was shut out of the market because the defendants conspired to deny insurance coverage for its product to shield themselves from patient demand for it. Holding that the seller stated a claim under section 1 of the Sherman Act, the Third Circuit reversed dismissal of the complaint and remanded for further proceedings.

The Department of Justice’s Antitrust Division issued the following statement today after announcing the closing of its investigation into Highmark’s affiliation agreement with West Penn Allegheny Health System (WPAHS).