Self-Funded Health Plans and Cross-Plan Offsetting
A recent court decision highlights an administrative process known as cross-plan offsetting. On January 15, 2019, in Peterson v. UnitedHealth Group, Inc., the court determined that the cross-plan offsetting was impermissible when the written plan terms did not authorize this practice. Based on the court’s ruling, employers should review and understand whether their TPA engages in cross-plan offsetting and whether there is language in the plan documents to support this practice. Further, it is advisable to review whether to continue cross-plan offsetting or “opt-out” of this practice.
Briefly, cross-plan offsetting is a mechanism used by third-party administrators (“TPAs”) to resolve overpayments to a provider made through one plan by withholding (or reducing) payment to the same provider through another plan.
Download the PDF to read our 3-page synopsis of additional key items you need to know.
|Date:||June 13, 2019|