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Seventh Circuit: Medical Provider Entitled to Third Party Fee Schedules
AVYM Healthcare Revenue Consultants Link to more items from this source
Dec. 3, 2018

"[T]he court reasoned that requiring Dr. Griffin to name a specific plan provision entitling her to higher reimbursement, was not necessary, since she clearly alleged she was not paid the usual, reasonable and customary amounts, consistent with section 1109 of the plan.... [The court further stated:] 'An assignee designated to receive benefits is considered a beneficiary and can sue for unpaid benefits under section 1132(a)(1)(B) ... It follows that Dr. Griffin also must be a beneficiary able to sue when she is denied requested information.' " [Griffin v. TEAMCARE,No. 182374 (7th Cir. Nov. 26, 2018)]

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