BarbriSFCourseDetails
  • videocam Live Webinar with Live Q&A
  • calendar_month April 21, 2026 @ 1:00 p.m. ET./10:00 a.m. PT
  • signal_cellular_alt Intermediate
  • card_travel ERISA
  • schedule 90 minutes

Out-of-Network ERISA Claims: Identifying Provisions Subject to Provider Challenge

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$297.00
$252.45
Save $44.55

Discount expires 4/7/26

This course is $0 with these passes:

CLE
ALL
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About the Course

Introduction

This CLE course will provide counsel with a thorough and practical guide to pursuing out-of-network payment claims under ERISA and state law theories. The panel will outline the conditions under which providers generally succeed in obtaining reimbursement for out-of-network claims under Section 502(a)(1)(B) and offer guidance on what factors to consider in pursuing or defending a claim. The program will also highlight efforts by out-of-network providers to assert claims that fall outside the scope of ERISA.

Description

Reimbursement disputes between healthcare providers and out-of-network providers have increased sharply in recent years. These disputes involve critical legal and practical considerations that counsel must have a full understanding of to handle out-of-network payment claims under ERISA effectively.

Section 502(a)(1)(B) claims arise when health plan fiduciaries or administrators deny a claim for benefits that the plaintiff alleges are due under the healthcare plan. Multiple lawsuits challenging the billing and payment practices between out-of-network providers and health insurers emphasize the need for plans to include unambiguous anti-assignment language in health plan documents and summary plan descriptions to avoid or limit out-of-network claims and for medical providers to enter strong assignment and personal representative agreements with their patients and to engage in a fulsome benefit verification process with payors.

ERISA counsel needs a clear understanding of plan language provisions and other factors that will render out-of-network payment denials subject to a successful challenge by providers.

Listen as our experienced panel provides a practical guide to challenges to out-of-network denials under ERISA and offers practical techniques for pursuing claims.

Presented By

Amanda L. Genovese
Partner
Seyfarth Shaw LLP

Ms. Genovese is a trusted advocate with a strong track record of success in high-stakes litigation, arbitration, mediation, and class action defense. Known for her strategic insight and calm under pressure, she is a key legal partner to clients navigating complex legal challenges. Ms. Genovese is known for representing several of the nation’s largest companies in their most complex disputes. Named a “Rising Star” at the 2022 New York Legal Awards by the New York Law Journal (ALM), she earns the confidence of executive teams and consistently delivers excellent results. As go-to outside counsel for health care and ERISA litigation, Ms. Genovese defends insurers, plan administrators, employers, and managed care organizations. She regularly delivers favorable outcomes in high-stakes reimbursement and network agreement disputes, securing dismissals and negotiating settlements. Ms. Genovese also advises clients on investigations and matters involving improper billing/coding, fraud and abuse laws, the Mental Health Parity Act, and government health care programs.

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Teresa Pofok
Shareholder
Tucker Arensberg, P.C.

Ms. Pofok is a shareholder in Tucker Arensberg’s Litigation Department and a seasoned ERISA attorney with three decades of experience representing employee benefit plans. Her practice spans health, welfare, retirement, and apprenticeship/training plan matters, with clients across a wide range of industries. In additional to providing benefits advice to employers, Ms. Pofok serves as general counsel to numerous health and retirement plans and provides practical, compliance-focused advice grounded in both her legal experience and her prior work as a compliance consultant with an actuarial consulting firm. She regularly advises on legislative compliance and plan operations involving the Mental Health Parity, Cyber Security Best Practices, SECURE Act, SECURE Act 2.0, the Affordable Care Act (ACA), COBRA, HIPAA, the American Rescue Plan Act of 2021, and multiemployer funding legislation. Ms. Pofok has successfully guided several multiemployer pension plans through the Special Financial Assistance program, helping restore their long-term financial solvency.

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Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.


  • Live Online


    On Demand

Date + Time

  • event

    Tuesday, April 21, 2026

  • schedule

    1:00 p.m. ET./10:00 a.m. PT

I. Challenges to denial of out-of-network payments based on fee-forgiveness provisions

II. Recent cases and key arguments raised in the pursuit of out-of-network claims

III. Bad faith claims in network negotiations as a factor in denying out-of-network reimbursement claims

IV. Factors for plaintiff counsel to consider in pursuing claims under ERISA Section 502(a)(1)(B)

The panel will review these and other key issues:

  • What is the impact of fee forgiveness provisions in plan documents on out-of-network reimbursement claims?
  • What other factors can lead to successful challenges of out-of-network claim denials by carriers?
  • What is the anticipated impact of recent court decisions on payors' out-of-network policies?