Johns Hopkins files $2M suit against Maryland health plan

Tue, 03 Jun 2008 06:59:54 -0400

Johns Hopkins Healthcare has sued regional Blue plan CareFirst of Maryland for $2 million, claiming that it owes that sum for claims made since October 2004. Johns Hopkins says that CareFirst, the region's largest health plan, denied or underpaid for nearly 15,000 claims for service performed through April 30. It also claims that CareFirst cut some already-negotiated Medicare reimbursement rates without disclosing those changes, as well as using outdated fee schedules and making mathematical mistakes.

Hopkins is asking the Circuit Court of Baltimore County to address these issues, as well as determine whether CareFirst is the primary payer for members also covered by Medicare or other federally funded health plans.

To learn more about the dispute:
- read this Baltimore Business Journal article

DC health mandate generates pullout threat from provider

Tue, 06 May 2008 06:59:55 -0400

As states and other governmental bodies consider health reforms, there have been some repercussions in the business community, of course. In DC's case, the impact could be quite severe, as the region's largest private healthcare provider may pull its physician network--along with its planned $5 million annual contribution--out of the region if DC's current reform package goes through. The District's Healthy DC legislation originally would have required that its 45,000 uninsured residents receive special subsidized health coverage, which would be available for premiums of between $20 and $100 per month, or else pay a $250 fine. It would be made available to those making more than $21,000 per year who couldn't afford traditional coverage.

The city had entered into a contract with CareFirst BlueCross BlueShield, a not-for-profit health insurer, to provide the special coverage. However, CareFirst has since expressed concerns that the $50 million program might not be financially viable.

To learn more about the dispute:
- read this Washington Post article
- read this statement from D.C. Councilmember David A. Catania, who backs the reforms

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