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Employee Retirement Income Security Act (ERISA) › Health Care Providers › Benefit Plan Sponsors

Haynes Boone

A Plan Document a Day Keeps the Physician Lawsuits Away

Haynes Boone on

Physicians generally do not have direct standing to bring a claim for benefits under an ERISA group health plan. Rather, a physician’s standing derives from the patient’s status as a plan participant and must be assigned....more

Hall Benefits Law

9th Circuit Explains ERISA Preemption of State Law Claims Arising from Preservice Coverage Communications

Hall Benefits Law on

The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more

Hall Benefits Law

The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors

Hall Benefits Law on

Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more

Jackson Walker

Health Plan Changes in the Consolidated Appropriations Act, 2021

Jackson Walker on

The protections for participants and their beneficiaries in the Patient Protection and Affordable Care Act (ACA) were expanded by the Consolidated Appropriations Act, 2021 (the “Act”). Some of the changes build on concepts in...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Eighth Circuit Upholds Payment for Out-of-Network Air Ambulance Flight at 150 Percent of Medicare Rates

Hinshaw & Culbertson LLP on

In Mitchell v. Blue Cross Blue Shield of N.D., 2020 U.S. App. LEXIS 8818 (8th Cir. Mar. 20, 2020), the Eighth Circuit upheld the payment of 150% of Medicare rates for an out-of-network air ambulance flight, although the...more

K&L Gates LLP

K&L Gates Triage: Health Care Provider v. Payor Disputes Simplified: Getting Around ERISA Preemption

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses the recent Louisiana federal district court decision in Crescent City Surgical Centre vs. United Healthcare of Louisiana, in which the court found that an out-of-network...more

McDermott Will & Schulte

Class Certification Denied in ERISA Health Coverage Lawsuit

McDermott Will & Schulte on

A federal district court denied class certification to health plan participants who claimed the plan promised them lifetime benefits. The court found too many individualized questions about what the plan told each...more

King & Spalding

How To Get Around ERISA Anti-Assignment Provisions

King & Spalding on

Under the Employee Retirement Income Security Act (“ERISA”), health care providers can file legal actions to recover employee benefits if they obtain a proper assignment of the patient’s benefits. Increasingly, however, ERISA...more

Foley & Lardner LLP

Details Matter: Medical Plan Anti-Assignment Clauses Protect Employers

Foley & Lardner LLP on

Yes, details matter. This is true on many fronts, including whether the documents governing the medical plan offered to employees prohibit employees and their dependents from assigning their plan benefit rights to a health...more

Winstead PC

2018 Benefits Grab Bag - Tax Reform, Bipartisan Budget Act and Other Items

Winstead PC on

Even though the Tax Cuts and Jobs Act made some changes to how the Internal Revenue Service (the “Service”) is to adjust retirement plan contribution limits late last year, the Service confirmed that the limits on retirement...more

McAfee & Taft

The skinny on narrow networks

McAfee & Taft on

The insurance exchanges created under Affordable Care Act have facilitated increased competition. Old version managed care models implemented cost-savings measures like pre-authorizations for medical care, hospital length of...more

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