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Health Care Providers Face Uphill Battle in Challenging Plan Eligibility Decisions
Health Plan Law 
July 5, 2007
Excerpt: The refunded Medicaid payment amounted to $76,291.63. The case underscores the vulnerability of health care providers to proper eligibility determinations. As an assignee, a provider will face the same difficulties as plan participants in overturning plan administrator decisions under the generous abuse of discretion standard of review.
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