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Expert Analysis

Out-Of-Network, Out Of Luck? Not Necessarily

Law360, New York (June 2, 2015, 11:05 AM EDT) -- 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 is reimbursed by the benefits plan administrator (whether an insurance company or otherwise) at a rate much lower than the amount charged, if at all. The provider then embarks upon the often Sisyphean journey of navigating the plan's lengthy and nebulous appeals process....

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