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Federal Court Sides With Payers on No Surprises Act IDRE Selection Process: What Providers Need to Know Now

A recent decision from the US District Court for the Eastern District of New York has significant implications for providers navigating the No Surprises Act (NSA) independent dispute resolution (IDR) process....more

Mental Health Parity: In a Pair of Decisions, California Federal Court Rejects United’s Efforts to Kick Behavioral Health Class...

Within the last month, the US District Court for the Northern District of California rejected efforts by United Behavioral Health (UBH) to dismiss and decertify two class actions seeking relief related to UBH’s processing of...more

Cross-Plan Offsetting: Recent Eighth Circuit Opinion Affirms Dismissal of Cross-Plan Offsetting Case Concluding Plaintiffs Did Not...

In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by...more

Ninth Circuit Reissues Opinion for the Second Time in Suit Challenging United Behavioral Health’s Mental Health Coverage...

Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more

Ninth Circuit Reverses Decision Requiring Reprocessing of 67,000 Behavioral Health Claims; Hands United Healthcare a Win 

The Ninth Circuit Court of Appeals recently reversed the Northern District of California’s landmark decision against UnitedHealth Group Inc.’s behavioral health unit, United Behavioral Health (“UBH”), under which UBH had been...more

Supreme Court Set To Rule This Spring on ERISA Investment Fees, Affecting Over 150 Cases Around the Country

The U.S. Supreme Court heard oral argument to decide a circuit split and determine what ERISA requires of ERISA-governed pension plan fiduciaries with respect to investment fees and recordkeeping. A decision is expected in...more

Eighth Circuit: A State Statute that Implicitly Regulates ERISA Plans Is Preempted by ERISA

Last month, in Pharmaceutical Care Management Association v. Tufte et al. No. 18-2926 (8th Cir. August 7, 2020), the United States Court of Appeals for the Eighth Circuit invalidated legislation in North Dakota on the grounds...more

Third Circuit Upholds Anti-Assignment Provision Barring Provider’s ERISA Suit Against Insurer

The US Court of Appeals for the Third Circuit recently confirmed that “anti-assignment” provisions — provisions prohibiting insureds from assigning their rights under a health plan to third parties, including medical...more

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