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Keeping you afloat amidst the rising sea of regulations

The Fifth Circuit Takes a Fresh Look at ERISA Benefit Claims Review Standard

In a recent 8-6 en banc decision, Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174, 2018 WL 1096980 (5th Cir. Mar. 1, 2018), the Fifth Circuit Court of Appeals overturned its precedent, to step in line with the majority of other circuits.

Can a Healthcare Plan Dictate Where a Medical Provider May Sue It?

The issue of where a medical provider with an assignment of benefits may sue an ERISA-governed healthcare plan for unreimbursed medical care is important.

Examining State Law Claims Under ERISA At Second Circuit

Medical providers seeking to pursue state law claims for payment from health care payers scored a win in the Second Circuit last month in a holding that affirms providers’ ability to hold health care insurers and other payers to their payment representations and promises.

Church-Affiliated Benefit Plans Exempt from ERISA: What the Supreme Court’s Ruling Means for Healthcare Providers

The Supreme Court issued a stunning ERISA decision on Monday, overturning the law in the three federal circuits as to what constitutes a “church plan” that is exempt from ERISA’s requirements. In Advocate Health Care Network v. Stapleton, 581 U. S.

The Ninth Circuit Speaks on Health Care Providers’ ERISA Rights

A recent decision from the Ninth Circuit Court of Appeals in DB Healthcare, LLC v. Blue Cross Blue Shield of Arizona, Inc., No. 14-16518, 2017 WL 1075050 (9th Cir. Mar. 22, 2017) reaffirms that health care providers are not health plan “beneficiaries” with the ability to sue under ERISA. Health care providers may sue under ERISA’s civil enforcement provisions only when armed with robust assignments of benefits and rights from patients and where the governing Plan documents do not prohibit assignments.

Medical Providers: How NOT to State an ERISA Claim

The 7th Circuit just denied ERISA rights to medical providers, but this doesn’t have to be the result. On October 1, 2015, the Court of Appeals for the Seventh Circuit issued a decision holding that in-network chiropractors were limited to the remedies available under their network contract with Blue Cross and could not invoke rights under the Employee Retirement Income Security Act (ERISA).