Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims.  The letters are usually 20 to 30 pages long, not very specific, and make various accusations against the plan and its fiduciaries. 

Most of the letters follow a standard approach.  They start by alleging breaches of fiduciary duty, they request all sorts of plan documents, and they request additional appeals to which the participant may or may not be entitled.  The biggest problem is that these letters are never very specific in exactly what they want.  Instead, they make vague accusations, and hope some or all will stick. Read More ›

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