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Category: Health Insurance

Your ERISA Watch – First Circuit Rules in Favor of Harvard Pilgrim Health Care in Dispute Over Denied Residential Treatment Benefits

This week’s notable decision demonstrates the difficulty of overcoming a district court’s de novo review on appeal in an ERISA case. Like many courts deciding mental health benefits under ERISA, the First Circuit concluded: “This case is not an easy…

Your ERISA Watch – Eighth Circuit Rules North Dakota Law Regulating Pharmacy Benefit Managers is Preempted by ERISA

This week’s notable decision comes from the Eighth Circuit and concerns claims preempted by ERISA. In Pharm. Care Mgmt. Ass’n v. Tufte, No. 18-2926, __F.3d__,2020 WL 4554980 (8th Cir. Aug. 7, 2020), Plaintiff Pharmaceutical Care Management Association (“PCMA”) claimed that…

Your ERISA Watch – In Mental Health Treatment Dispute, Tenth Circuit Holds De Novo Review Applies Where There Is No Notice of Discretionary Authority

This week we highlight a notable circuit court decision involving a denial of a mental health claim.  The Tenth Circuit case, Lyn M. v. Premera Blue Cross, No. 18-4098, __ F.3d __, 2020 WL 4249129 (10th Cir. July 24, 2020),…

Your ERISA Watch – Finding No ERISA Preemption, Third Circuit Revives Out-of-Network Provider Claims Against Aetna

This was an exciting week in ERISAland!  We highlight three notable decisions in the areas of ERISA preemption and out-of-network provider claims, proton beam radiation therapy and standing, and pension benefit claims. This week’s first notable decision, ­­­­­­­­­­­­­­Plastic Surgery Ctr.,…

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