Trio of Recent Cases Find Health Care Provider Claims for Underpayment of Benefits Preempted by ERISA
27 January 2010
Mayer Brown Legal Update
Health insurance providers and managed care organizations faced with provider claims for underpayment of benefits (due to downcoding, bundling, or non-payment of claims) benefitted from a trio of cases decided in the last quarter of 2009. Although they applied the same line of demarcation as prior cases, these three cases found that the disputed claims may be preempted by ERISA where the claims sufficiently related to coverage determinations.