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Disclaimer Shields Claims Administrator from Mispresentation Claims in Health Services Case
Health Plan Law 
[Guidance Overview] Dec. 2, 2008
Excerpt: This recent case out of the Southern District is one that the payer community can chalk up as a win. The facts are a bit harsh. Tenet did attempt to 'verify' coverage - and the claims administrator did so affirmatively - but with important reservations. So when it turned out that the patient actually had been terminated from coverage, a fact unknown to the claims administrator (it appears), Tenet bore the burden of the loss.
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