LA Hospital Can Force Anthem to Cover ER Visits, 9th Cir. Rules

Oct. 5, 2020, 2:56 PM

A Los Angeles hospital won its lawsuit to make Anthem Inc. pay for about 75 emergency room visits from covered patients, when the Ninth Circuit said the hospital was validly assigned the patients’ benefit payments.

Anthem argued the case was blocked by an “anti-assignment” provision in its health plan that prevented patients from assigning their rights to third parties like the Martin Luther King Jr. Community Hospital.

The U.S. Court of Appeals for the Ninth Circuit disagreed in an unpublished split decision, saying the language cited by Anthem specifically allowed assignments to “providers,” including out-of-network Martin Luther King.

The court...

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