Protecting Healthcare Providers' Rights to Benefits Under ERISA: Assignment of Benefits and Right to Sue

Lessons from Inconsistent Court Treatment, Dealing With Anti-Assignment Clauses, Ensuring Standing

Recording of a 90-minute CLE webinar with Q&A


Conducted on Thursday, December 8, 2016

Recorded event now available

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Program Materials

This CLE webinar will provide guidance to healthcare counsel on protecting the rights of healthcare providers to benefits under ERISA. The panel discussion will include assignments of benefits (AOBs), anti-assignment clauses and right to sue clauses, as well as how the courts are treating these issues.

Description

Recent court decisions have underscored the importance of AOBs for healthcare providers seeking reimbursement against insurers for services rendered, particularly when providers assert claims under ERISA. Because providers are not ERISA plan participants or beneficiaries, a provider’s standing -- and ability to challenge an insurer’s reimbursement decision -- depends on whether the provider has an enforceable AOB. For example, if a healthcare provider did not get an AOB from a patient, the provider may not be able to pursue litigation at all. And, even if the provider did receive an AOB, the language and breadth of the AOB, or an anti-assignment clause in the underlying health insurance plan, may prevent the provider from bringing suit entirely or from bringing certain claims.

Some federal courts have reached inconsistent conclusions regarding whether an assignment of the right to payment confers standing to sue. For example, in New Jersey Brain & Spine Ctr. v. Aetna Inc. (3d Cir. 2015), the Third Circuit considered whether a patient’s explicit assignment of payment of benefits to the healthcare provider is enough to give the provider standing to sue under ERISA. The court held that a healthcare provider obtains standing when a patient assigns payment of insurance benefits to the provider.

However, in Peacock Med. Lab. v. UnitedHealth Gp. (S.D. Fla. 2015), the district court concluded that a medical lab did not have standing to sue under ERISA despite the patients having signed AOBs. The court determined the assignment only conferred limited standing to receive benefits.

Listen as our authoritative panel of healthcare practitioners examines what healthcare providers can do to protect their rights to benefits under ERISA. The panel will discuss structuring AOBs and right to sue clauses. The panel will also examine lessons that can be learned from recent court decisions and address anti-assignment clauses and steps providers should take to ensure standing.

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Outline

  1. Healthcare providers’ rights to ERISA benefits
  2. Assignment and anti-assignment clauses
  3. Right to sue
    1. Administrative action/appeals
    2. Ltigation
  4. Recent court treatment

Benefits

The panel will review these and other key issues:

  • What can counsel for healthcare providers do to protect the provider’s rights to ERISA benefits when seeking payment for healthcare services to the ERISA beneficiary?
  • How are the courts treating the issues of assignment and standing when plan beneficiaries assign their claims for payment of benefits to their healthcare provider?
  • What steps can healthcare counsel take to overcome anti-assignment provisions in a patient’s ERISA plan?

Faculty

Jason P. Lacey
Jason P. Lacey

Partner
Foulston Siefkin

Mr. Lacey practices primarily in the areas of income taxation, ERISA, employee benefits, and executive compensation. He...  |  Read More

Lauren Garraux
Lauren Garraux

K&L Gates

Ms. Garraux is an experienced commercial litigator. She counsels and litigates on behalf of health care providers in a...  |  Read More

Jessica Guobadia
Jessica Guobadia

Law Office of Joseph V. Gibson

Ms. Guobadia's practice focuses on health law, business and commercial law, contractual disputes and reviews,...  |  Read More

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