Under ERISA claims procedure regulations, group health plans must provide a “full and fair” review of all claims submitted by plan participants. These claims procedure regulations provide a list of minimum standards, including determinations within a certain timeframe, specific content requirements of adverse notifications, and the opportunity to submit evidence through an internal administrative appeal
Tenth Circuit to Decide Case that Could Substantially Change Health Plan Denial Letters
By Virginia Bell Flynn & Angie Shewan on
Posted in All Entries, Regulatory Enforcement + Compliance
In October 2022, the Tenth Circuit heard oral argument in D.K. et al. v. United Behavioral Health et al., a case that could significantly impact what health plans must include in any notification to claimants of an adverse benefit determination, i.e. benefit denial letters.
Under ERISA’s claims procedure regulations, there is an express list…