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Preemption › Employee Retirement Income Security Act (ERISA) › Out of Network Provider

Robinson+Cole ERISA Claim Defense Blog

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on...

Robinson+Cole ERISA Claim Defense Blog on

Within days of one another, the U.S. Court of Appeals for the Ninth and Second Circuits ruled—on issues of first impression for both—that ERISA expressly preempts state law breach of contract and promissory estoppel claims...more

Troutman Pepper

Ninth Circuit Court of Appeals Restricts Out-of-Network Providers’ Ability to Avoid ERISA Preemption of State Law Claims

Troutman Pepper on

On May 31, the Ninth Circuit Court of Appeals published an opinion in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, which has significant implications for the healthcare industry, most notably by...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor - October 2020: Third Circuit Rules State Law Reimbursement Claims Brought by Out-of-Network Medical...

Hinshaw & Culbertson - The LHD/ERISA Advisor on

In Plastic Surgery Center, P.A. v. Aetna Life Ins. Co., 2020 U.S. App. LEXIS 22274 (July 17, 2020), the Third Circuit held that an out-of-network medical provider's state law claims against an insurer were not precluded by...more

Epstein Becker & Green

Third Circuit: Provider’s Out-of-Network Claims not Pre-empted by ERISA

Epstein Becker & Green on

In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more

Manatt, Phelps & Phillips, LLP

[Webinar] COVID-19: The Road Ahead for Commercial Health Insurance - April 23rd, 2:00 pm - 3:00 pm ET

Manatt, Phelps & Phillips, LLP on

Examine the Evolving Challenges That Lie Ahead for Healthcare Stakeholders and State Regulators—and What You Can Do Now to Prepare and Protect Your Organization—at a New Manatt Webinar. Effective health insurance...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

Seyfarth Shaw LLP

Out Of Network Provider’s Claim Against Health Insurer Avoids ERISA Preemption

Seyfarth Shaw LLP on

Seyfarth Synopsis: A provider that is not seeking benefits based upon an assignment of a patient’s claims under ERISA but instead is pursuing state law claims based solely on agreements and representations made directly by...more

Epstein Becker & Green

New Jersey’s Surprise Medical Bill Law: Part 1: Regulatory Issuances by New Jersey Agencies

Epstein Becker & Green on

Earlier this year, New Jersey Governor Phil Murphy signed into law the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“Law”), creating a statutory framework attempting to protect...more

Proskauer - Employee Benefits & Executive...

Out-of-Network Physician’s Claim Against Insurer Not Preempted by ERISA

Proskauer - Employee Benefits & Executive... on

The Second Circuit concluded that a promissory estoppel claim by an out-of-network provider against an insurer was not completely preempted by ERISA and thus remanded the claim to state court for further proceedings. The...more

K&L Gates LLP

Out-of-Network, Out of Luck? A Growing Body of Caselaw Addressing Claims by Out-of-Network Providers Seeking Full Reimbursement...

K&L Gates LLP on

It’s become a common scenario for medical providers: a provider treats a patient covered by employer-provided health insurance for which the provider is out-of-network, receives an assignment of benefits from the patient and...more

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