Court Steers Clear of Declaring ERISA Violation
Health care providers brought class actions on behalf of patients against the administrator of health insurance plans alleging the administrator's practice of cross-plan offsetting between in-network and out-of-network plans resulted in wrongfully failing to pay providers in violation of Employee Retirement Income Security Act (ERISA). The Eighth Circuit upheld summary judgment for the plaintiffs ruling nothing in the plan documents authorizes cross-plan offsetting and the interpretation of the plan otherwise was not reasonable. The court would go no further, declaring it need not decide whether cross-plan offsetting necessarily violates ERISA. However, it said in this case, “at the very least it approaches the line of what is permissible” and clearer language is required on plan documents.