Out-of-Network ERISA Claims: Identifying Provisions Subject to Provider Challenge
Anti-Assignment Clauses, Leveraging Ambiguities in Fee Forgiveness Provisions, Bad Faith, and Other Factors
Recording of a 90-minute premium CLE video webinar with Q&A
This CLE course will provide counsel with a thorough and practical guide to pursuing out-of-network payment claims under ERISA and state law theories. The panel will outline the conditions under which providers generally succeed in obtaining reimbursement for out-of-network claims under Section 502(a)(1)(B) and offer guidance on what factors to consider in pursuing or defending a claim. The program will also highlight efforts by out-of-network providers to assert claims that fall outside the scope of ERISA.
Outline
- Challenges to denial of out-of-network payments based on fee-forgiveness provisions
- Recent cases and key arguments raised in the pursuit of out-of-network claims
- Bad faith claims in network negotiations as a factor in denying out-of-network reimbursement claims
- Factors for plaintiff counsel to consider in pursuing claims under ERISA Section 502(a)(1)(B)
Benefits
The panel will review these and other key issues:
- What is the impact of fee forgiveness provisions in plan documents on out-of-network reimbursement claims?
- What other factors can lead to successful challenges of out-of-network claim denials by carriers?
- What is the anticipated impact of recent court decisions on payors' out-of-network policies?
Faculty
Alison Lima Andersen
Partner
ArentFox Schiff
Ms. Anderson’s work is primarily in the areas of ERISA and other employee benefits litigation, healthcare... | Read More
Ms. Anderson’s work is primarily in the areas of ERISA and other employee benefits litigation, healthcare litigation, and complex commercial litigation. Her recent litigation work includes representing medical providers seeking reimbursement from commercial health plans and insurers; defending companies and retirement plans against breach of fiduciary duty and benefits claims; and defending several defendants accused of violating the Medicare Secondary Payer Act. She also has recent experience in municipal and corporate bankruptcy; as well as in class action cases involving claims of government lending and disability discrimination.
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David M. Mohl
Attorney
Katten Muchin Rosenman
Mr. Mohl helps clients navigate the complex regulatory landscape of ERISA, the Internal Revenue Code, the Affordable... | Read More
Mr. Mohl helps clients navigate the complex regulatory landscape of ERISA, the Internal Revenue Code, the Affordable Care Act, COBRA, HIPAA, and various federal and state laws affecting employee benefits. His practice covers the design, implementation and administration of employee benefit plans as well as the defense of plans and plan fiduciaries in government investigations. Mr. Mohl has significant experience representing fiduciaries in complex ERISA litigation disputes in both arbitration and class action lawsuits. He also has experience representing Taft-Hartley plans, focusing on the unique challenges that face multiemployer plans and contributing employers.
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