Beginning last year, there has been a rash of court decisions giving ERISA participant and/or beneficiary status to providers based on assignments executed by participants at the point of service. The most recent case was issued last week from the United States District Court for the Eastern District of Pennsylvania. In the case, HOWARD BLOOM, D.C. and WEATHER VANE CHIROPRACTIC, P.C. v. INDEPENDENCE BLUE CROSS, the District Court once again granted ERISA participant status to the provider, based on an assignment executed by the participant at the point of service. This is a dangerous trend as it grants to the provider all ERISA rights, including claims and appeals rights. Further, as more and more providers (and their representatives) start to realize how easy it is to hijack ERISA rights, providers can easily turn what is normally only a provider and TPA payment dispute into a huge ERISA issue for the plan sponsor.However, it’s also a trend that can be easily stopped by plan sponsors. Plan sponsors can stop the threat of these cases by placing proper language in their health plan documents and SPDs to prevent the application of provider assignments. At the same time, plan sponsors should also insert proper procedures to follow to appoint a person as a participant’s ERISA authorized representative, which is also another avenue that providers have used to turn a provider/TPA dispute into an ERISA issue.
While we are pleased to have you contact us by telephone, surface mail, electronic mail, or by facsimile transmission, contacting Kilpatrick Townsend & Stockton LLP or any of its attorneys does not create an attorney-client relationship. The formation of an attorney-client relationship requires consideration of multiple factors, including possible conflicts of interest. An attorney-client relationship is formed only when both you and the Firm have agreed to proceed with a defined engagement.
DO NOT CONVEY TO US ANY INFORMATION YOU REGARD AS CONFIDENTIAL UNTIL A FORMAL CLIENT-ATTORNEY RELATIONSHIP HAS BEEN ESTABLISHED.
If you do convey information, you recognize that we may review and disclose the information, and you agree that even if you regard the information as highly confidential and even if it is transmitted in a good faith effort to retain us, such a review does not preclude us from representing another client directly adverse to you, even in a matter where that information could be used against you.