[firm] blog logo

Does Your TPA Use Cross-Plan Off-Setting? Eighth Circuit Questions Its Compliance with ERISA

The third-party administrator (?Ç£TPA?Ç¥) in this case, UnitedHealth Group and its related entities (?Ç£UnitedHealth?Ç¥), engaged in ?Ç£cross-plan offsetting?Ç¥, which involves not paying a claim under Employer A?ÇÖs group health plan in order to recover an overpayment made by Employer B?ÇÖs group health plan to the same healthcare service provider. For example, assume UnitedHealth overpaid a provider by $200 on behalf of Employer B?ÇÖs group health plan, and a participant in Employer A?ÇÖs group health plan incurred a $250 claim with that same provider. UnitedHealth would only pay the provider $50 on behalf of the participant in Employer A?ÇÖs group health plan. The U.S. Court of Appeals for the Eighth Circuit agreed with the federal district court that UnitedHealth?ÇÖs interpretation of the plans was unreasonable and cross-plan offsetting was not permitted under the plans because (i) interpretations that authorize practices that push the boundaries of what ERISA permits should be viewed… Continue Reading

January 2019
S M T W T F S
 12345
6789101112
13141516171819
20212223242526
2728293031  

Archives