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Navigating Out-of-Network Claims: Key Takeaways for Providers From Surgery Center Case in New York Federal Court

The US District Court for the Eastern District of New York in Manalapan Surgery Ctr., et al. v. 1199 SEIU National Benefit Fund, No. 23-CV-03525 (EDNY March 12, 2025), recently granted a motion to dismiss a complaint filed by...more

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...more

Buyer Beware: Health Plans Need to Exercise Caution in Retaining Third-Party Administrators and Medical Claim Reviewers

A federal court in Nebraska recently rejected a health plan’s fiduciary breach claims under the Employee Retirement Income Security Act of 1974 (ERISA) against third-party service providers, holding that the service providers...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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