ERISA and hospital charges: granting an inch, not a mile.
Some claims review services" have cited ERISA as an authority allowing an ERISA plan administrator to reduce a hospital's billed charges based on "the reasonable value of services." However, nothing in ERISA allows a plan administrator to change the terms of a contract between a payer and a provider, or places any limitations on the structure or price of hospital charges.
Fedor
Frank
F
Murphy Austin Adams Schoenfeld, LLP, Sacramento, Calif, USA. ffedor@murphyaustin.com
D032982:Contracts; D019461:Employee Retirement Income Security Act; D033161:Government Regulation; D017722:Hospital Charges / Q000331:legislation & jurisprudence*; D014481:United States