Special report on liability and insurance. An update on assignment of patient benefits under ERISA.
While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.
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D001131:Arkansas; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics / Q000331:legislation & jurisprudence; D002140:California; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence; D007347:Insurance, Dental / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D010415:Pensions