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Court Allows Provider to Proceed With Claim That Plan Violated Cost-Sharing Limit
Thomson Reuters / EBIA 
July 6, 2018
"The hospital asserted that the plan essentially established a reference price when it reimbursed all of the hospital's services at 140% of Medicare's allowed charge. Because the plan's network did not include any hospitals or otherwise ensure access to hospitals that would accept the reference price, the hospital contended that the plan was required to count out-of-pocket expenses for charges over the reference price toward the maximum annual cost-sharing limit[.]" [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)]
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