image

Health Insurance Recovery for Corporations

Overview

Building on our firm’s national reputation in representing policyholders against insurance companies, the Anderson Kill Healthcare Team excels in helping corporations nationwide navigate the impossibly complex and often convoluted insurance issues that arise in the context of healthcare.

Hospitals, Health Systems and Providers

The Anderson Kill Healthcare Team represents hospitals, health systems, institutional providers and individual providers or groups in connection with large-scale payment disputes. Although this specialty does not involve insurance policies directly, Anderson Kill’s industry-leading experience in insurance coverage is a perfect complement to the legal issues that arise from the contractual relationships between these clients and the health insurance industry. We have successfully tackled the chronic issues of slow pays, low pays, and no pays, both in court and through negotiation. We have a strong track record of ensuring that our clients receive the reimbursements they expected and that they contracted to receive.

Employer-Sponsored Health Plans

Our Healthcare Team boasts extensive – and unique –experience helping employers address the government mandate to provide health benefits to their employees. The biggest challenges arise when employers opt for self-funding and find themselves deeply entrenched in legal issues and obligations that have no connection to their business operations. When employers suddenly find themselves adverse to the entities they thought would guide them through the process – their third-party administrators, stop-loss insurance companies and even the brokers who put them into these plans – the solution is our Healthcare Team. We will understand the problems that the employers are unable even to explain.

We do not know of another law firm that specializes in representing employers as sponsors of fully insured and self-funded health plans, much less another law firm that has taken such cases through trial. Our notable achievements as health insurance recovery counsel include significant victories, both in court and through pre-litigation resolutions. For example, in a Southern District of New York action—Aetna Insurance Company v. Esselte Corporation—we secured a jury verdict in favor of a self-funded plan that had wrongly been sued by Aetna, which served jointly as its TPA and its stop-loss insurer. Not only was Aetna’s claim denied, Aetna also was ordered to pay Esselte’s legal fees.

Disability and Life Insurance

Our Healthcare Team has decades of experience representing individual policyholders who have wrongly been denied their disability and life insurance benefits, after a lifetime of timely premium payments. We thrive in ensuring that justice is done on these David-versus-Goliath playing fields. We know, from experience, what steps to take and what missteps to avoid. We also know what these insurance policies – that supposedly are written in “plain language,” but often are impenetrable – actually mean and say.

Through our comprehensive and nuanced approach, the Anderson Kill Healthcare Team remains dedicated to protecting the interests of corporations nationwide navigate the health insurance arena with confidence and success, and ensuring that hospitals, health systems and providers of all types are treated fairly by health insurance companies – even within a system that appears to be rigged.

Experience

  • National Fire & Marine Insurance Co v. [Redacted]. A nationwide operator of senior residential facilities was named as a defendant in a declaratory judgment action filed by National Fire & Marine Insurance Co. The dispute regards coverage under professional liability policies for claims arising from bodily injury from COVID-19 in more than 1,700 assisted care facilities owned and/or operated by the policyholder. A matter of first impression, the case was fast-tracked for litigation and trial. The District Court ruled in favor of plaintiffs. We appealed to the U.S. Court of Appeals for the Third Circuit, which overturned the lower court’s ruling.
  • NYU Langone Hospitals v. Aetna Health, Inc. et. al (N.Y. Supr. Ct, NY Cty). Lead counsel to NYU Langone Hospitals in a breach of contract and bad faith claim against Aetna for systemic underpayments and non-payments for services rendered. Recovery was sought in excess of $25 million, including 12% interest for violations of NYS Prompt Pay Law (NY Ins. Law §3224-a). Following denial of dueling motions for summary judgment, NYU Langone filed a renewed motion for partial summary judgment in August 2021 in accordance with directions from the Court. While judgment on that motion was pending, the case settled in November 2021, with full resolution in 2022.
  • Aetna Ins. Co. et. al. v. Esselte Corporation (U.S. District Court, S.D.N.Y.). Lead trial counsel to office products manufacturer with regard to self-funded employee benefit plan; obtained jury verdict in favor of the plan in April 2005, along with reimbursement of legal fees it incurred in defending against the lawsuit filed by Aetna in its dual capacities as third-party administrator and stop-loss insurance company.
  • Niesenbaum v. AXA/Equitable Life Insurance Co. (N.Y. Supr. Ct., Nassau Cty). Lead counsel to plaintiff physician in coverage action against disability insurance company; achieved confidential settlement after defeating summary judgment motion filed by insurance company seeking dismissal of bad faith count under Bi-Economy. See Niesenbaum v. AXA/Equitable Life Insurance Co., 2015 NY Slip Op. 32538 (N.Y. Supr. Ct., Nassau Cty 2015).
  • Cohen v. Standard Ins. Co. (U.S. District Court, E.D. Pa.). Lead counsel to plaintiff law partner; obtained summary judgment for policyholder, including attorney’s fees, in ruling that insurance company’s refusal to pay disability claim was arbitrary and capricious. See Cohen v. Standard Ins. Co., 155 F. Supp. 2d 346 (E.D. Pa. 2001).
  • Kodsi v. Empire Blue Cross (N.Y. Supreme Ct., N.Y. County). Lead counsel to plaintiff physician arising for suit alleging wrongful termination by insurance company in retaliation for physician challenge to non-payments by insurance company; obtained ruling from NY State Supreme Court that it violates NY law for PPOs to terminate providers without cause.
  • Lead counsel to Colt’s Manufacturing Company LLC in confidential mediation against hospital, stop-loss insurance company and third-party administrator, arising from long-overdue hospital bill for services rendered under a self-insured health plan. The complex multi-party dispute was resolved.
  • Counsel to numerous corporations and foreign embassies regarding self-funded benefits plans, self-administered insurance policies and self-insurance arrangements, including securing recovery of unpaid sums without resort to litigation, avoiding payment of sums not owed by the corporations or their plans, and analyzing SPDs, administration agreements, stop-loss insurance policies and related documents.

Publications

Cyberattacks are bankrupting health care providers. Insurance may help.
  • Medical Economics
image
Use the Affordable Care Act as a Sword at Renewal Time Or…Your Insurance Company Will Use It Against You
  • Enforce
image
Beyond Health Insurance: What Your Company Should Be Doing Today to Protect Against New Risks Created by the Affordable Care Act
  • Enforce
image
THE AFFORDABLE CARE ACT “PLAY OR PAY” REQUIREMENTS TAKE EFFECT JANUARY 1, 2014—ARE YOU READY?
  • Agents of America
image
SUPREME COURT RULES THAT AFFORDABLE CARE ACT IS CONSTITUTIONAL RISK MANAGEMENT DEPARTMENTS: SAY HELLO TO HR
  • Policyholder Advisor & Alert
image
HEALTH CARE MANDATES? NOTHING NEW FOR FOREIGN STUDENTS
  • AOL News
image
EMPLOYERS AND HEALTH REFORM: DO YOU KNOW WHAT YOUR CURRENT OBLIGATIONS ARE?
  • Corporate Counsel
image
U.S. Health Care Reform: Should Foreign Entities Care?
  • Italy-America Chamber of Commerce
image
WHEN COVERAGE IS DENIED UNDER HEALTH REFORM, THE GROUND RULES FOR APPEALS NO LONGER APPLY
  • Policyholder Advisor & Alert
image
NO TIME LIKE THE PRESENT: CURRENT INSURANCE RECOVERIES FOR PRESENT LIABILITIES THAT INCLUDE FUTURE COSTS AND CLAIMS
  • Policyholder Advisor & Alert
image
NO REST FOR THE WEARY EMPLOYER THE NEW MEDICARE REPORTING REQUIREMENTS
  • Policyholder Advisor & Alert
image
LEVELING THE PLAYING FIELD – GOODBYE TO THE HEALTH INSURANCE ANTITRUST EXEMPTION
  • MarketWatch
image
The Genetic Information Nondiscrimination Act: A New Challenge for Self-Funded Employers
  • Self-Funding Advisor
image
SEVEN “DEADLY SINS” TO AVOID WHEN NEGOTIATING SELF-FUNDED BENEFIT PLANS
  • Corporate Counsel
image
HOSPITAL PRIVILEGES: FEDERAL V. STATE LAW?
  • Anderson Kill's Healthcare Newsletter
image
EMPLOYERS WHO FAIL TO GIVE HEALTH CARE CONTINUATION NOTICES MAY END UP WITH A NASTY “COBRA” BITE
  • Employment Law Insider & Alert
image
ERISA PREEMPTION: GOING, GOING…ALMOST GONE?
  • Anderson Kill's Pharmaceutical & Healthcare Insurance Alert
image

News

Third Circuit Tosses Insurer Win in Nursing Home Coverage Row
  • December 27, 2023
image
Health Care Co. Seeks Full Coverage For COVID Claims
  • October 11, 2022
image
Female Powerbrokers Q&A: Anderson Kill’s Rhonda Orin
  • January 15, 2014
image
Supreme Court Rules that Affordable Care Act Is Constitutional
  • June 29, 2012
image
Rhonda Orin Writes Book on Managed Care
  • January 13, 2004
image

People

image
Cameron R. Argetsinger

Shareholder , Washington, DC

image
image
John M. Leonard

Shareholder , New York

image
image
Bruce Strong

Shareholder , New York, Philadelphia

image
image
Madilynne Lee

Attorney , Philadelphia

image
Key Contact(s)
image
Rhonda D. Orin
View Moreimage

Recommended Reading

Making Them Pay: How to Get the Most from Health Insurance and Managed Care is Rhonda Orin's practical advice for people who are frustrated with how insurance companies intentionally write health insurance plans like jigsaw puzzles: exclusion and exceptions, loopholes and lingo, and lots technical language. The Wall Street Journal named it one of the top health books of 2000.

Self-Administering, Insuring and Funding Benefits Plans is Rhonda Orin's explanation of the various advantages and disadvantages of life, health, and disability benefits...a perplexing array of alternatives. This chapter helps corporate leaders understand these alternatives, compare them, decide among them, and, ultimately, manage the one that is selected, as well as understand contract negotiation and evaluation.

© Copyright 2024 by Anderson Kill P.C.