June 7, 2017Speaking Engagement

Health Care Provider Litigation

American Bar Association ERISA Litigation National Institute

In the health plan context, in-network and out-of-network providers alike have recently been invoking ERISA, sometimes successfully and sometimes not, to litigate pay and reimbursement disputes against insurance companies. These cases present interesting issues involving ERISA preemption (i.e., do these claims actually arise under ERISA or state law?), standing of the providers to assert ERISA claims on behalf of their patients who participate in ERISA plans, the enforceability and scope of patient assignments of rights, the applicability of ERISA’s claim/appeal procedures and exhaustion requirements, the availability of class certification, and the scope of potential “appropriate equitable relief” under Section 502(a)(3).


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