menu
  • Our Story

    • Overview
    • Careers
    • Locations
    • Diversity, Equity & Inclusion
    • Pro Bono
    • Community Involvement
    • Firm Leadership
    • History
    • Alumni
    • Affiliations
    • Media Inquiries
    • Make a Payment
  • Our People

  • Our Insights

    • Events/CLE
    • Publications
    • News
    • Blogs
  • Our Practices & Industries

    • Business
      • Business Transitions
      • Construction
      • Corporate, Securities and M&A
      • ERISA, Life, Health & Disability
      • Finance & Banking
      • Immigration
      • Intellectual Property Transactions
      • Labor, Employment & Benefits
      • Private Client Services
      • Private Investment Funds
      • Real Estate
      • Startups & Emerging Companies
      • Tax
      • Wage & Hour
    • Litigation
      • Antitrust, Competition, & Trade
      • Appellate
      • Class Actions
      • Commercial Litigation
      • Construction
      • Creditors' Rights & Bankruptcy
      • Electronic Discovery, Technology & Strategy
      • ERISA, Life, Health & Disability
      • Fiduciary Litigation
      • Financial Institutions Litigation & Investigations
      • Insurance
      • Intellectual Property Litigation
      • International Arbitration
      • Labor, Employment & Benefits
      • Securities & Corporate Governance Litigation
      • Wage & Hour
    • Industries
      • Blockchain & Cryptocurrency
      • Food, Beverage & Hospitality
      • Government Law
      • Investigations, Compliance & White Collar
      • Japan Practice
      • Nonprofit & Social Enterprise
      • Privacy & Data Security
      • Senior Living & Long Term Care
      • Transportation
    • Services
      • COVID-19 Landlord/Tenant Response Team
      • COVID-19 Resource Center
      • Cyber Health Assessment
      • Lumos Discovery
  • Our Locations

    • Anchorage
    • Portland
    • Seattle
  • Our Careers

    • Attorneys
    • Summer Associates
    • Professional Staff
  • Our Diversity

    • Diversity, Equity & Inclusion
    • Our Story
Lane Powell Web Site
  • OUR PEOPLE
  • STORY
  • INSIGHTS
  • PRACTICES & INDUSTRIES
Search
  • 日本語
  • 中文
  • 한국어
Email this pagePrint this pagePrint to PDF

Related People

  • Barbara J. Duffy

Related Practices & Industries

  • Commercial Litigation
  • Insurance
  • Litigation

UnitedHealthcare Insurance Co. Self-Insured Employee Health Plan Arbitration

We represented a healthcare insurer against an arbitration demand filed by a petitioner hospital requesting payment of amounts allegedly owed under an in-network provider contract with our client. The demand arises out of a self-insured employee health plan for which our client administered claims on behalf of a major corporation. A plan member’s newborn triplets who spent several months in the hospital had primary insurance through their father’s health plan. Our client’s plan provided secondary coverage. Both the primary insurer and our client had in-network contracts with the hospital limiting the maximum charges. The primary insurer’s contract rate was lower than our client’s contract rate. Following its normal nationwide practice, our client processed the triplets’ claim using the primary plan’s negotiated rate as the allowable charges, based on the hospital having written off any charges in excess of that rate. This payment method ensures that the health insurance covers only those costs actually charged to the patient, fully covering the patient’s liability but preventing the hospital from charging the secondary insurer more than it charged the patient herself. While a state regulation arguably would require a fully-insured insurance plan to pay the higher of the two contracted rates, ERISA preempts the state regulation as to this self-funded plan. On our motion for summary judgment, the arbitration panel agreed that our client properly calculated the health plan payments, the plan did not cover charges written off by the hospital under its agreement with the primary insurer, and nothing in our client’s contract with the hospital required additional payments. Partial summary judgment was granted in September, dismissing all but approximately $1,500 of petitioner’s claims. Settlement discussions on the remaining issue are ongoing.

Before proceeding, please note:  If you are not a current client of Lane Powell PC, please do not include any information in this email that you or someone else considers to be confidential or secret in nature.  Prior to the establishment of a lawyer-client relationship, unsolicited emails from non-clients containing confidential or secret information cannot be protected from disclosure.

back to top
  • Our Story

    • Overview
    • Careers
    • Locations
    • Diversity, Equity & Inclusion
    • Pro Bono
    • Community Involvement
    • Firm Leadership
    • History
    • Alumni
    • Affiliations
    • Media Inquiries
    • Make a Payment
  • Our People

    • Our Insights

      • Events/CLE
      • Publications
      • News
      • Blogs
    • Our Practices & Industries

      • Business
      • Litigation
      • Industries
      • Services
      • View All

    Blogs

    Boom: The ERISA Law Blog
    Earth & Table Law Reporter

    • Site Map
    • Disclaimer
    • Data Privacy & Security
    • Contact Us
    • Subscribe
    © 2021 Lane Powell PC Lane Powell & LP
    Logo, Reg. U.S. Pat. & Tm. Off.
    Sitemap
    Connect With Us
    • Twitter
    • Facebook
    • Linkedin
    • Vimeo
    • Make a Payment