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Self-Funded Health Plans and Cross-Plan Offsetting

Overview:

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.

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Self-Funded Health Plans And Cross-Plan Offsetting - 050619U
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Arthur Grutt