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Imagine a health-care system in which doctors and nurses are so exhausted and beaten down that many of them work like zombies — error-prone, apathetic toward patients and at times trying to blunt their own pain with alcohol or even suicide attempts.

That is what America’s broken health care system is doing to its health workers, according to a 312-page report released Wednesday by the National Academy of Medicine, one of the country’s most prestigious medical institutions.

The report found that as many as half of the country’s doctors and nurses experience substantia...

A federal jury decided Tuesday that insurer Blue Shield of California underpaid a California hospital system for emergency medical services provided to Blue Shield's members.

The jury in the U.S. District Court in San Francisco determined that Blue Shield must pay out-of-network NorthBay Healthcare Group 67% of its billed charges since the end of 2016. King & Spalding, the law firm representing NorthBay, estimated that it would recover more than $16 million, but the exact amount has not yet been decided.

In a statement, however, Blue Shield said the case went to tria...

Fairfield, Calif.-based NorthBay Healthcare may recover $16 million-plus from Blue Shield of California after a federal jury in San Francisco found the health insurer underpaid the hospital system for emergency care.

On Feb. 13, after a six-day trial, the jury found Blue Shield owed NorthBay 67 percent of its billed charges, according to law firm King & Spalding, which represented NorthBay. The exact amount of damages has yet to be determined, but is currently estimated at more than $16 million.

The case stems from December 2016, when Blue Shield and NorthBay ended...

Blue Shield of California is unfairly targeting hundreds of thousands of Covered California enrollees with a coverage change that would prevent them from getting routine care when they are working outside of California, one enrollee told The Sacramento Bee.

Philip Martin has been trying to get Blue Shield to reverse its decision to limit out-of-state medical coverage for PPO members whose policies didn’t go into effect before Jan. 1, 2014, the date when coverage under the Affordable Care Act went into effect. Blue Shield is limiting out-of-state coverage to urgent c...

CentraState Medical Center in Freehold Thursday became the latest hospital to drop a three-year-old lawsuit against Horizon Blue Cross Blue Shield of New Jersey that accused the state's dominant health insurance provider of squeezing community hospitals out of the market.

CentraState was once one of seven hospitals that sued Horizon for relegating them to a more expensive tier in the company's OMNIA discount health plans, which Horizon said would revolutionize health care options in the state.

Valley Hospital in Ridgewood, the last plaintiff in the case, an...

Ashley Summers said she got an unpleasant surprise in February when she tried to pick up a prescription for her rheumatoid arthritis: Her pharmacy said her insurance had been canceled, even though her premiums were paid.

Summers called Blue Shield of California and got her policy reinstated — then she said it happened again in March and this time, the lapse in coverage dragged on for three months.

Without insurance to cover her medications and doctor visits, her arthritis and fibromyalgia worsened to the point that she could barely walk, she said. In June, she said,...

A federal judge in Newark has granted final approval to a $160 million settlement on behalf of out-of-network ambulatory surgical centers which claimed the insurance company’s policies did not provide adequate reimbursement for services rendered.

U.S. District Judge Kevin McNulty approved the settlement terms and granted $9 million in legal fees on Friday, ending a 12-year litigation saga over claims that New Jersey’s largest health insurer shortchanged ambulatory surgical centers outside its provider network.

The suit that just settled, Edwards v. Horizon Blue Cross...

Members who have health coverage through Blue Shield of California are suing the insurer, alleging the company owes $35 million in additional rebates because it included faulty payments within its medical-loss ratio a few years ago.

Two Blue Shield members, Becky Ebenkamp and Rebecca Morris, filed the class-action lawsuit on behalf of more than 446,000 other people who bought an individual Blue Shield plan in 2014.

One of the lead attorneys for the plaintiffs is Jay Angoff, a former Missouri insurance commissioner and former director of the CMS' Center for Consum...

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