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Fifth Circuit Confirms ERISA Does Not Preempt Medical Provider?ÇÖs State Claims Against Insurance Company; Overrules Prior Cases

The company, Access Mediquip (?Ç£Access?Ç¥), procures medical devices to be used during surgeries by health care providers.?á Access first contacts insurance companies to ensure that its medical devices are covered prior to procurement.?á Access had received prior authorization for a medical device from UnitedHealthcare; however, UnitedHealthcare later denied the reimbursement claim from Access by stating it would only cover such devices when billed by surgical facilities.?á The U.S. District Court for the Southern District of Texas found that ERISA preempted Access?ÇÖ state law claims seeking reimbursement from UnitedHealthcare.?á However, on appeal, the U.S. Court of Appeals for the Fifth Circuit reversed the district court with respect to Access?ÇÖ claims for negligent misrepresentation, promissory estoppel and violations of the Texas Insurance Code.?á UnitedHealthcare then petitioned for a rehearing en banc, arguing that the Fifth Circuit?ÇÖs decision was inconsistent with its prior opinions.?á On the rehearing en banc, the Fifth Circuit reinstated… Continue Reading

October 2012
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