Ruling Gives Ammunition in Fights Over Health Insurer Clawbacks

Doctors, hospitals, and other medical providers now have a loaded arsenal to fight back with when health insurers try to claw back money they overpaid in claims for one patient by withholding payment for another in a separate health plan.

Benefits attorneys say a recent ruling from a federal district court in New Jersey gives ammunition to providers fighting to stop insurers from engaging in this routine billing practice, known as cross-plan offsetting. The court ruled the practice violates the Employee Retirement Income Security Act. It’s a decision that could lead to more lawsuits, but also prompt changes to plan ...