Migliaccio & Rathod LLP is investigating whether certain employer-sponsored health plans included incorrect provider directories that resulted in patients being improperly charged out-of-network rates from telling them that a doctor or medical facility was in-network.
Patients often rely on their insurer’s website, provider directory, telephone representatives, or online chat system when deciding where to receive care. Federal law provides protections in certain situations where a patient relies on inaccurate network information supplied by a health plan.
We are investigating cases in which a patient checked whether a provider was in-network, was told that the provider was in-network, received treatment, and was later surprised when the claim was processed as out-of-network.
We are also investigating patients undergoing continuing treatment—such as pregnancy care, cancer treatment, or treatment for a serious condition—whose doctor or facility unexpectedly left the network and who may not have received applicable protections for continuing care.
You May Be Affected If:
- You receive health insurance through your private-sector employer, or through a spouse’s or parent’s private-sector employer;
- Your insurer’s website or provider directory listed your doctor or facility as in-network;
- A health-plan representative told you by telephone, email, or online chat that the provider was in-network;
- You relied on that information when obtaining treatment;
- The claim was later processed as out-of-network and you paid more as a result; or
- You were undergoing ongoing treatment when your doctor or facility left the network and your plan immediately began charging you out-of-network rates.
Screenshots, emails, online-chat transcripts, telephone reference numbers, EOBs, and medical bills can be particularly helpful.
Why This Matters
Patients should be able to rely on the network information their health plan provides when deciding where to receive care.
An incorrect provider directory can result in thousands of dollars in unexpected charges, particularly where the patient reasonably believed the doctor, hospital, or treatment center was in-network.
The issue may be especially serious for patients receiving ongoing care who cannot easily change providers without disrupting treatment.
Does This Apply to Your Health Plan?
This investigation generally concerns ERISA-covered health plans obtained through private-sector employment.
Both self-funded employer plans and plans purchased from insurance companies may qualify. Government employee plans and certain church plans generally do not.
If you are unsure whether your plan qualifies, we can help determine that from your insurance card, Summary Plan Description, Explanation of Benefits, provider-directory screenshots, or other plan documents.
We Are Interested in Hearing From Patients Who:
- checked their insurer’s directory before choosing a provider;
- called or messaged their health plan to confirm that a provider was in-network;
- were later billed at out-of-network rates;
- paid more because the network information was inaccurate;
- have screenshots or other proof showing the provider was listed as in-network;
- were in the middle of pregnancy, cancer care, surgery, or other ongoing treatment when a provider left the network; or
- have EOBs, bills, emails, or chat transcripts showing what happened.
If your employer-sponsored health plan charged you out-of-network rates from incorrect provider directories or after telling you that a facility was in-network, we would like to hear from you. Please complete the contact form on this page, send us an email at [email protected], or call us at (202) 470-3520.