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.
Continue reading...As we were ready to wrap-up the year, the U.S. Supreme Court decides yet another arbitration case. In Union Pacific v. Brotherhood of Locomotive Engineers, 558 U.S. ___(Dec. 8, 2009), the issue before the Court was whether pre-arbitration conference was a jurisdictional requirement. We will post a summary of the case after we read it and it will be added to our 2009 Year-End post as well.
Continue reading...Continuing with our 2009 Year-End Highlights series, we present today a summary of noteworthy arbitration opinions handed down by the Texas Supreme Court. The landmark case In re Poly-America, L.P. , 262 S.W.3d 337 (Tex. 2008) decided in 2008, involves a retaliatory-discharge claim. The court concluded that fee-splitting schemes in an arbitration agreement are unconscionable. (post available here) In February, the court decided three arbitration-related cases: (1) In In re: Labatt Food Service, L.P. the court resolves the issue of whether nonsignatories to an arbitration agreement should be compelled to arbitrate claims when the decedent’s claims would have to be arbitrated. (2) In re Jindal followed Labatt‘s precedent. The court held that an arbitration agreement between a decedent and his employer required the nonsignatories beneficiaries to arbitrate their claims. (3) In re Bank of America, N.A., presents the the issue of enforceability of contractual jury waivers. The court analyzed their similarities with arbitration clauses, both falling within the category of forum- selection clauses. In April, the court ruled on In re Gulf Exploration, LLC. The issue was whether mandamus review of orders compelling arbitration should be entirely precluded. (post available here) In June, the court decided two arbitration-related cases: (1) In re International Profit Associates, Inc. The court held that a party challenging a forum-selection clause has the burden of proving the clause is invalid. (post available here) (2) The court held that a post-injury arbitration acknowledgment agreement is valid and compelled arbitration of tort claims within the context of an employment contract. In re Macy’s Texas, Inc. (post available here) Perhaps the most significant case decided this year by the Texas Supreme Court was In re Morgan Stanley & Co., Inc. The court applied Prima Paint‘s separability doctrine, Prima Paint Corp. v. Flood & Conklin Manufacturing Co., 388 U.S. 395 (1967). The court declined to follow Fifth Circuit precedent and held that the court, not the arbitrator should decide the issue of capacity to contract. (post available here and comments by Professor Alan Scott Rau are here) In July, the court held that a district court abused its discretion by permitting discovery instead of deciding a motion to compel arbitration, In re Houston Pipe Line Co. (post available here) In October, the court decided In re Polymerica. The court held that an agreement to arbitrate discrimination claims between an employee and a staffing agency hired by the employer survives the dissolution of the contract between the staffing agency and employer. (post available here) Also in October, Chrysler Insurance Co. v. Greenspoint Dodge of Houston, Inc., was decided by the court. The case deals with a dispute over insurance coverage to pay for a $1.5 million defamation arbitration award granted to a former employee. (post available here) In November, the court held in In re Golden Peanut Co., that wrongful death beneficiaries nonsignatories to an arbitration agreement must be compelled to arbitrate when the decedent’s claims would had been arbitrated. (post available here) Technorati Tags: arbitration, ADR, law, Texas Supreme Court
Continue reading...Welcome to Disputing‘s 2009 Year-End Highlights. During this year, the U.S. Supreme Court decided several cases related to arbitration: On March 9, the Court decided Vaden v. Discover Bank. The issues were (1) whether a district court, if asked to compel arbitration, should “look through” the petition and grant the relief if the court would have federal-question jurisdiction of the controversy and (2) whether a district court should exercise jurisdiction over the petition when the petitioner’s complaint rests on state law but an actual or potential counterclaim rests on federal law. (post available here) On April 1, the Court decided 14 Penn Plaza v. Pyett. The issue resolved by the Court was whether a provision in a collective-bargaining agreement that clearly and unmistakably requires union members to arbitrate claims arising under the Age Discrimination in Employment Act is enforceable. (posts available here and here) On May 4, the Court decided Arthur Andersen LLP v. Carlisle. The issues decided were (1) whether appellate courts have jurisdiction under Section 16(a) of the FAA to review denials of stays of litigation requested by nonparties to the arbitration agreement and (2) whether Section 3 of the FAA can ever mandate a stay of litigation by nonparties to the arbitration agreement. (post available here) On June 15, the Court granted certiorari to Stolt-Nielsen S.A., et al. v. AnimalFeeds International Corp., to decide whether the FAA permits class arbitration when the arbitration agreement is silent. The case will be heard by the Court on December 9, 2009. (post available here and Professor Alan S. Rau comments here). [update: transcript of the Dec. 9 argument is here] The Court also vacated and remanded the Sixth Circuit decision in Kimberlin v. Renasant Bank for further consideration in light of Arthur Andersen LLP v Carlisle. (post available here) On October 5, the Court denied certiorari to three “manifest disregard of the law” cases: The Coffee Beanery, Ltd. v. WW, LLC, 300 Fed. Appx. 415 (6th Cir. 2008); Grain v. Trinity Health, 551 F.3d 374 (6th Cir. 2008); and Comedy Club, Inc. v. Improv West Associates, 553 F.3d 1277 (9th Cir. 2008). (order list 558 U.S. is here) [update:] Finally, in December, the Court decided Union Pacific v. Brotherhood of Locomotive Engineers, 558 U.S. ___(Dec. 8, 2009). The issue before the Court was whether a pre-arbitration conference was a jurisdictional requirement under the Railway Labor Act. (post available here) Technorati Tags: arbitration, ADR, law, U.S. Supreme Court
Continue reading...Disputing is published by Karl Bayer, a dispute resolution expert based in Austin, Texas. Articles published on Disputing aim to provide original insight and commentary around issues related to arbitration, mediation and the alternative dispute resolution industry.
To learn more about Karl and his team, or to schedule a mediation or arbitration with Karl’s live scheduling calendar, visit www.karlbayer.com.
Disputing is published by Karl Bayer, a dispute resolution expert based in Austin, Texas. Articles published on Disputing aim to provide original insight and commentary around issues related to arbitration, mediation and the alternative dispute resolution industry.
To learn more about Karl and his team, or to schedule a mediation or arbitration with Karl’s live scheduling calendar, visit www.karlbayer.com.