Assignment of ERISA Health Care Claims

Benefits Magazine
In this article, Timothy O'Toole and Michael Khalil discuss the common questions that arise in connection with the assignment of a beneficiary's right for payment under their health plan directly to their provider. Often, the provider uses this assignment to stand in the shoes of the beneficiary at the administrative level, and possibly even in federal court. When a health plan provider asks a patient to assign benefits, the plan administrator must know how to respond. The authors examine how the plan administrator should treat the assignee, whether the precise language of the assignment form matters in the administrator's response, and whether all assignments are even valid. The authors also discuss ERISA's allowance for participants to assigns claims, when a plan can prohibit assignments, the enforceability of anti-assignment clauses and the impact of the Patient Protection and Affordable Care Act (ACA) impact on any of the rules.
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Assignment of ERISA Health Care Claims