Examining State Law Claims Under ERISA At Second Circuit
Medical providers seeking to pursue state law claims for payment from health care payers scored a win in the Second Circuit last month in a holding that affirms providers’ ability to hold health care insurers and other payers to their payment representations and promises.
In McCulloch Orthopaedic Surgical Services PLLC v. Aetna Inc., No. 15-2150, 2017 (2d Cir. May 18, 2017), the Second Circuit set out to decide “whether [the Employee Retirement Income Security Act] ERISA completely preempts an out-of-network health care provider’s promissory estoppel claim against a health insurer where the provider (1) did not receive a valid assignment for payment under the health care plan and (2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.” The court held that ERISA does not completely preempt this type of claim.
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