U.S. Supreme Court Finalized Lawsuit against United Healthcare for Out-Of-Network Providers – Webinars Announced from ERISAclaim.com

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On February 25, 2013, the U.S. Supreme Court denied a Petition by United Healthcare (UHC) to review a Federal Appeals Court en banc decision against UHC for an out-of-network health care provider. ERISAclaim.com announced new webinars on analysis and practical application of the Supreme Court landmark decision.

By denying UHC’s petition, the Supreme Court has finally clarified and finalized the first Provider’s Bill of Rights in 2013......

On February 25, 2013, the U.S. Supreme Court denied a Petition for a writ of certiorari by United Healthcare Insurance Company (UHC) to review an en banc decision by the Federal Court Of Appeals for the Fifth Circuit (5th Cir.) on October 5, 2012 against UHC for an out-of-network health care provider on behalf of more than 2,000 patients. The en banc 5th Cir. Court ruled against UHC on its defense that ERISA preempts an out-of-network provider's state law claims against UHC for alleged negligent misrepresentation, promissory estoppel, and violations of the Texas Insurance Code. The Supreme Court UHC decision on February 25, 2013 finalized the 5th Cir. Court UHC decision as the law of the land for all healthcare claim denials for both in-network and out-of-network patients and providers. ERISAclaim.com timely announced new webinars, executive brainstorming and consulting, advanced ERISA training, and litigation support, in order to provide advanced analysis and practical solutions as a result of the Supreme Court UHC decision on February 25, 2013.

The Supreme Court UHC case info:
United Healthcare Insurance Company v. Access Mediquip L.L.C., No.: 12-806, Supreme Court of the United States, Lower Court: United States Court of Appeals for the Fifth Circuit, Case No.: 10-20868, Petition DENIED, February 25, 2013.

DOL Access Mediquip Amicus Brief, in support of Out-of-network Provider:

ERISAclaim.com’s new webinars and related services will focus on (1) the complete and in-depth analysis of the legal and practical impact of the Supreme Court UHC decision and 5th Cir. Court legal reasoning against UHC ERISA preemption defense in the provider’s coverage and out-of-network UCR dispute: ERISA does not preempt the provider’s claims for alleged UHC’s negligent misrepresentation and state law violations independent from the ERISA plan interpretation; (2) effective application of the new law of the land in all provider administrative appeals and judicial reviews in federal court; and (3) effective ERISA claim regulation compliance by plan administrators and fiduciary supervision on TPA ERISA compliance to avoid unnecessary fiduciary and TPA liabilities.

“To successfully appeal and litigate healthcare claim denials, healthcare providers and their attorneys must be well informed of ERISA preemption in order to prevail for both ERISA claims and state law claims,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

D. Brian Hufford of Pomerantz Grossman Hufford Dahlstrom & Gross LLP in New York, counsel for Access, said Monday that the company was “very pleased” with the decision and looked forward to proceeding with the case in district court after the "important precedent" established by the Fifth Circuit.

“The issues raised in this case are not unique to our client, but affect providers across the country whose services are being improperly denied reimbursement following representations by insurance companies that coverage is available,” Hufford said.

According to the Fifth Circuit en banc decision, “The court took en banc this case, which raises questions about the scope of liability of an ERISA plan administrator and fiduciary for allegedly misrepresenting a plan beneficiary’s coverage in its advice to a provider of health devices.”

Without any detailed explanation, the Court made a very short en banc decision: “Having reconsidered this case en banc, we reinstate the panel opinion and overrule, to the extent inconsistent with its reasoning, the court’s opinions in Cypress Fairbanks, Hermann I and Hermann II. The judgment of the district court is REVERSED and the case REMANDED for further proceedings consistent herewith.”

On July 11, 2012, DOL filed an Amicus Brief in 5th Cir. Court in support of plaintiff, the out-of-network provider:

“Without any legal remedies, health care providers can no longer rely as freely [on representations of health care coverage] and must either deny care or raise fees to protect themselves against the risk of noncoverage. . . . [T]he employees whom Congress sought to protect would find medical treatment more difficult to obtain…….the Secretary requests the en banc Court to adopt the panel decision's reasoning and holding regarding the non-preemption of the plaintiff's state law claims for promissory estoppel, negligent misrepresentation, and violations of the Texas Insurance Code.”

“By denying UHC’s petition, the Supreme Court has finally clarified and finalized the first Provider’s Bill of Rights in 2013 - what the Congress really intended for ERISA preemption in protecting employees when seeking for healthcare services from healthcare providers, both in-network and out-of-network. Now it’s up to healthcare providers to take actions or not, to get paid or denied,” said Dr. Zhou.

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:

Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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