Fiduciary Duty, Out of Network Provider

Eighth Circuit Questions Whether Cross-Plan Offsetting Violates ERISA in Recent Decision Holding that the Underlying Plan...

King & Spalding on 3/13/2019

On January 15, 2019, the United States Court of Appeals for the Eighth Circuit considered whether certain plan documents allowed UnitedHealth Group Inc. and affiliates (“United”) to engage in a practice known as “cross-plan...more

Eighth Circuit Rejects Cross-Plan Offsetting

McDermott Will & Emery on 2/8/2019

A recent Eighth Circuit decision regarding “cross-plan offsetting” serves as an important reminder of how ERISA’s fiduciary duties impact both employers and fiduciaries who handle claims. The case involved the common...more

Eighth Circuit Rules that Cross-Plan Offsetting of Payments Is Unreasonable

King & Spalding on 1/29/2019

On January 15, 2019, the U.S. Court of Appeals for the Eighth Circuit issued an order affirming a lower court’s ruling that UnitedHealth’s interpretation of ERISA plan documents to authorize cross-plan offsetting was...more

Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

Snell & Wilmer on 10/11/2016

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims. The letters are usually 20 to 30 pages long, not very specific, and...more

Court Orders Cigna to Pay Out-of-Network Surgical Claims

King & Spalding on 6/9/2016

On June 1, 2016, the United States District Court for the Southern District of Texas ordered Cigna to pay nearly $13.7 million to Humble Surgical Hospital, LLC (“Humble”). Of the nearly $13.7 million, almost $11.4 million...more

Texas Hospital Strikes Back at Aetna

BakerHostetler on 8/31/2015

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more