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Employee Retirement Income Security Act (ERISA) › Assignments

King & Spalding

How To Get Around ERISA Anti-Assignment Provisions

King & Spalding on

Under the Employee Retirement Income Security Act (“ERISA”), health care providers can file legal actions to recover employee benefits if they obtain a proper assignment of the patient’s benefits. Increasingly, however, ERISA...more

Foley & Lardner LLP

Two Recent Examples of Challenges To Collect “Reasonable” Charges

Foley & Lardner LLP on

Two recent cases illustrate the continuing challenges providers, and in particular hospital providers, face when seeking to collect their charges when dealing with “out-of-network” patients....more

K&L Gates LLP

Recent 11th Circuit Decision Is a Victory for Health Care Providers Challenging Insurer Reimbursement Decisions and a Reminder of...

K&L Gates LLP on

The existence and scope of assignments of benefits from patients to health care providers continues to be critically important to a provider’s ability to challenge an insurer’s reimbursement decision under the Employee...more

Proskauer - Employee Benefits & Executive...

Out-of-Network Physician’s Claim Against Insurer Not Preempted by ERISA

Proskauer - Employee Benefits & Executive... on

The Second Circuit concluded that a promissory estoppel claim by an out-of-network provider against an insurer was not completely preempted by ERISA and thus remanded the claim to state court for further proceedings. The...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit: Medical Providers Lack ERISA Standing

Proskauer - Employee Benefits & Executive... on

The Ninth Circuit affirmed two district court decisions that concluded medical providers were not “beneficiaries” under Section 502(a) of ERISA and therefore lacked standing to bring an ERISA claim...more

Troutman Pepper

Health Care Providers Should Review Assignment of Benefit Forms After 9th Cir. Decision

Troutman Pepper on

A federal appeals court recently brushed aside the claims of several health care providers, in large part because of the language in the assignment forms signed by their patients. The opinion from the U.S. Court of Appeals...more

K&L Gates LLP

How Are Your Assignment of Benefits Clauses Drafted? Recent Third Circuit Decision Highlights the Importance of Review of Provider...

K&L Gates LLP on

Healthcare providers virtually always rely upon assignment of benefits agreements executed by patients as a basis for reimbursement from health insurers. When those insurers fail to reimburse the provider altogether, or fail...more

Faegre Drinker Biddle & Reath LLP

U.S. Third Circuit Allows Providers to Sue Health Insurers Directly

Faegre Drinker Biddle & Reath LLP on

For many years, the United States Court of Appeals for the Third Circuit was out of step with its sister Courts of Appeal when it came to the issue of suing health insurance companies for failing to cover the medical expenses...more

Alston & Bird

Third Circuit – Failure to Identify Plan’s Limitation Period in Denial Letter Precludes Enforcing Deadline

Alston & Bird on

In 2013, the Supreme Court reaffirmed that ERISA plans can impose shorter limitations periods than would otherwise be the case if the plan was silent. Nevertheless, the United States Court of Appeals for the Third Circuit...more

Williams Mullen

Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company

Williams Mullen on

The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage...more

Littler

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

Littler on

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

Proskauer - Employee Benefits & Executive...

Valid Assignment Confers Beneficiary Status on Chiropractor

Proskauer - Employee Benefits & Executive... on

A federal district court in Illinois recently issued a pair of rulings in cases where insurers sought to recoup payments from practitioners. Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, 2013...more

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