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Fifth Circuit Finds Out-of-Network Medical Provider Has Standing to Sue Health Plan
Seyfarth Shaw LLPLink to more items from this source
Apr. 24, 2015

"Relying heavily on the Ninth Circuit's 2014 decision in [Spinedex v. United Healthcare of Ariz.] the Fifth Circuit explained that courts 'look to the rights of the patient at the time of assignment.' It reasoned that participants have the right to be reimbursed by Cigna for medical costs incurred at an out-of-network provider, and the fact that participants assigned that right to the hospital 'does not cause [the right] to disappear.' As an express assignee of the patients' rights, the hospital had standing to sue for underpayment of benefits." [North Cypress Medical Ctr. Operating Co. v. Cigna Healthcare, No. 12-20695 (5th Cir. Mar. 10, 2015)]

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