Michelle Capezza Quoted in “Suit Aims to Stop Insurers from Using Health Plans as Piggy Bank”

Bloomberg Law

Michelle Capezza, Member of the Firm in the Employee Benefits and Health Care & Life Sciences practices, in the firm’s New York office, was quoted in Bloomberg Law, in “Suit Aims to Stop Insurers from Using Health Plans as Piggy Bank,” by Lydia Wheeler. (Read the full version – subscription required.)

Following is an excerpt:

A new lawsuit seeks to stop health insurers from a decade-old practice that some attorneys say treats patients’ health plans like their own personal piggy bank.

The practice, known as cross-plan offsetting, occurs when an insurance company that considers it overpaid a doctor for a patient’s care recoups that loss by refusing to pay the same doctor in full when they care for another patient in a different health plan serviced by the same insurance company. …

Call to Action

Benefits attorneys say the latest litigation shines a light on a practice employers, which offer health plans to their workers, may not be aware of.

“It’s a call to action for plan sponsors to really take a closer look at their service agreements with their claims administrators to determine if there is a documented process in those service agreements about how errors will be corrected,” said Michelle Capezza, a member of Epstein Becker & Green PC in the Employee Benefits & Executive Compensation and Health Care & Life Sciences practices. …

Employers may have to change service providers and examine their plan documents, she said, although she acknowledged changing providers could be difficult due to consolidation in the health insurance industry. …

“We’ll have to see if there’s law that comes down that forces these providers not to engage in this practice at all,” Capezza said.

In the interim, employers should look at their own plan documents to see how overpayments are handled and document any conversations with insurers if issues are raised, she said.