What to Do When You Receive an Out-of-Network Shakedown Letter

“A physician-owned, out-of-network health care service provider – such as an ambulatory surgery center or a sleep center – sends a demand letter to the plan administrator. The letter asserts an appeal of a denied benefits claim by one of the plan’s participants; requests copies of a lengthy list of plan-related documents; and alleges that the plan administrator, the plan sponsor, the plan’s third-party claims administrator, the insurance carrier and/or the plan itself have violated ERISA and other federal or state laws relating to plan administration or the participant’s benefits claim…. What should you do when you receive this kind of shakedown letter? And more importantly, what should you be doing to avoid getting a letter like this in the first place?” [Society for Human Resource Management (SHRM)]

By | 2017-11-14T08:18:13+00:00 November 13th, 2017|2017 News, News|