Health insurance companies to make changes to prior authorizations
HHS secretary Robert F. Kennedy and Dr. Mehmet Oz announced that major insurance companies have agreed to cut down and streamline prior authorizations
Californians who paid for health insurance from certain providers may be owed some money as part of a recent $228.5 million settlement.
The settlement resolves a class action lawsuit against Sutter Health of Sacramento stemming back years. Plaintiffs claimed that certain actions on Sutter Health’s part toward health plans violated state and federal antitrust and unfair competition laws, ultimately leading to higher insurance premiums for members of the lawsuit.
Sutter Health denies that it violated any antitrust or unfair competition laws or that its practices led to any increase in the cost of premiums for health insurance.
Those who believe they’re eligible for a payment need to submit a claim by Sept. 12. Here’s what else you should know to determine whether you’re entitled to any money.
Who is eligible to file a claim?
There are several criteria you have to meet to be eligible to receive a payment:
- You did not previously opt out of this lawsuit.
- You paid any portion of a premium for a fully-insured health insurance policy from Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, or United Healthcare sometime from Jan. 1, 2011, and March 8, 2021;
- And during the period you paid those premiums, you lived or worked in any of the following counties in the state:
| Alameda | Alpine | Amador | Butte |
| Calaveras | Colusa | Contra Costa | Del Norte |
| El Dorado | Glenn | Humboldt | Lake |
| Lassen | Marin | Mendocino | Merced |
| Modoc | Napa | Nevada | Placer |
| Plumas | Sacramento | San Francisco | San Joaquin |
| San Mateo | Santa Cruz | Shasta | Sierra |
| Siskiyou | Solano | Sonoma | Stanislaus |
| Sutter | Tehama | Trinity | Tuolumne |
| Yolo | Yuba |
Employers can also be eligible for this settlement.
Wait, what is a fully-insured health insurance policy?
A fully-insured health insurance policy is one where the premium is paid to the health plan and the health plan covers health care costs for the insured person, aside from copays, deductibles, and other fees, according to the settlement website. This is different from a self-insurance plan, in which an employer takes on most or all of the costs of benefit claims, according to Aetna. So, the insurance company manages the payments, but the employer is paying the claims, said Aetna.
The settlement administrators’ website has some recommendations if you don’t know whether the health insurance policy was fully insured. First, ask your employer or your health plan about this. If you can’t, assume you had a fully-insured policy because a final determination will ultimately be made later in the claims process.
Where can I file a claim?
Visit sutterhealthpremiumlawsuit.com to file a claim or get more information.
When will I receive payment?
Payments will be issued after the court grants final approval to the settlement and any appeals are resolved. A hearing to consider whether the settlement is fair is scheduled for Nov. 6. After the hearing, the court will decide whether to approve the settlement.
Paris Barraza is a trending reporter covering California news at The Desert Sun. Reach her at pbarraza@gannett.com.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.