Managed Care Disputes: Litigating Issues Involving Coverage, Payment Practices and More

The trend of payers, providers and members of managed care plans litigating over such issues as coverage, payment and network participation continues unabated. The changes in healthcare laws have added new disputes in areas such as medical loss ratio regulation, essential health benefits and network inclusion.

Changes in healthcare reimbursement are driving a trend toward tiered and narrow networks, which will only increase litigation over out-of-network reimbursement, the right to participate in managed care networks, and whether tiering arrangements are valid.

Listen as our authoritative panel of healthcare practitioners analyzes recent developments in managed care litigation, and discusses substantive, strategic and practical considerations involved in litigating managed care suits.

1. Hot topics in coverage litigation
2. ACA-related litigation
   1. Medical loss ratio requirements
   2. Provider inclusion and exclusion from networks
   3. Coverage disputes over emergent care and mental health benefits
3. Out-of-network reimbursement trends and litigation
4. ERISA litigation trends
5. Antitrust actions targeting insurer plans’ geographic distribution of markets
6. Payer actions challenging provider waivers of co-insurance, co-pays and deductibles

The panel will review these and other critical questions:

• What are the bases for the recent wave of managed care suits—and what defenses are available to providers and healthcare plans?
• What are proven litigation and settlement strategies for counsel litigating managed care claims?
• What are best practices for counsel to providers and healthcare plans to minimize the expanding risk of managed care suits?