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 webinar with Q&A
This CLE webinar will provide ERISA counsel with a thorough and practical guide to the pursuit of out-of-network payment claims under ERISA. 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.
- 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)
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?
Alison Lima Andersen
Ms. Andersen's recent litigation work includes representing medical providers seeking reimbursement from commercial... | Read More
Ms. Andersen's recent litigation work includes representing medical providers seeking reimbursement from commercial health plans and insurers; defending companies and retirement plans against breach of duty 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.Close
Andrew I. Hamelsky
White and Williams
For more than 20 years Mr. Hamelsky has been a commercial litigator with experience before state and federal courts and... | Read More
For more than 20 years Mr. Hamelsky has been a commercial litigator with experience before state and federal courts and arbitration panels. He has helped his clients achieve results by getting to the heart of each case using an aggressive, hands-on and responsive approach. Practicing from the firm’s New York and New Jersey offices, Mr. Hamelsky has been applying his result-orientated style in his representation of insurance companies and corporations in both jurisdictions.Close
Mark Johnson, Ph.D., J.D.
ERISA Benefits Consulting
Mr. Johnson has a 30 year career history bridging four closely related areas in Employee Retirement Income Security Act... | Read More
Mr. Johnson has a 30 year career history bridging four closely related areas in Employee Retirement Income Security Act (ERISA), pension, 401(k), group life, health and retiree medical plans administration, labor relations, human resources and personnel policies.Close