How the HCFA Form 1500 Can Make or Break ERISA Standing in Health Plan Disputes, by Henry Norwood, Esq. and Justin Russell, Esq., published by American Bar Association-Health Law Publication, 6-25-2024
In the course of seeking reimbursement for services rendered to patients, healthcare providers often face challenges to their claims from their patients’ insurers. If the insurers’ appeal processes do not resolve the disputes, providers may choose to bring suit in state or federal courts. Providers may find themselves at a disadvantage from the outset, however, because insurer defendants frequently leverage the very industry-standard forms that providers use to submit their claims in the first place as a potential defense. In a bid to create federal jurisdiction over a provider’s state law causes of action, insurers sometimes point to information that a provider has submitted on industry-standard health insurance claim forms indicating that the provider received an assignment of their patient’s claims. The issue has been addressed in several court decisions, which are explored in this article.
Reprinted with permission of the American Bar Association.
Read more at the full article.
