Recently, in a landmark decision for Out-Of-Network (OON) providers nationwide, a U.S. District Judge Kenneth Hoyt of the Southern District of Texas ruled against Cigna and ordered the insurer to pay $11.4 million to cover underpaid claims, and an additional $2.3 million in ERISA penalties. This is the first instance where a claims administrator was ordered to pay ERISA penalties to a medical provider.
In what is most likely a shift in out-of-network reimbursement and claims processing, the Court ruled that Cigna could not deny claims based on the purported waiver by Humble of patient’s deductibles, co-pays or co-insurance. Per the rules, Cigna had no right under ERISA to absolve itself from its responsibility to pay the claims because it assumed that it could demand upfront payment of deductibles, co-pays and co-insurance.
Out-of-network providers need to understand and utilize this important decision to compel health insurers to pay out-of-network claims. Join expert speaker Thomas J. Force, Esq.—a licensed attorney—in this informative session to get an easy break down of this complicated legal precedent and how it impacts OONs.
This 60-minute session is packed with tips and tricks regarding balance billing issues for the out of network provider.
Who should attend
Healthcare Executives, Physicians, Front Office and Billing Staff, Revenue Cycle Personnel, Practice Managers, Compliance Professionals & Attorneys
- Melody S. Irvine, CPC, CPMA, CEMC, CFPC, CPB, CPC-I, CCS-P
- Duane C. Abbey, Ph.D.
- Jeanne J. Chamberlin ,
- Rob J. Thurston ,
- Jim Sheldon-Dean,
- Jill M. Young, CPC, CEDC, CIMC
Thomas J. Force, Esq. is a licensed attorney since 1994 in both the state and federal courts for the states of New Jersey and New York with 27 years in the healthcare and insurance industries. He is the President and Founder of The Patriot Group, a full service health care physician advocacy and revenue recovery company providing billing, appeals, collections and follow up services for health care.A Former...
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