- Docket No.
- 2:26-cv-05756
- District Court
- New York Eastern
Goal
- Award damages
- Block defendant action
- Declaration that defendant action is unlawful
Issues
Litigation Content
Why This Matters:
Why this Matters:
A neurology practice challenges a health insurer’s decision to reduce reimbursement and potentially exclude in-network facilities (such as hospitals and ambulatory surgery centers) from plan networks if those facilities permit out-of-network clinicians (such as neurologists or anesthesiologists) to provide services to plan enrollees. The plaintiff alleges that this policy violates federal and state antitrust laws and is inconsistent with the federal No Surprises Act, which establishes a framework for certain out-of-network providers to seek reimbursement for care provided at in-network facilities.
Potential Impact:
Potential Impact:
Insurer policies that incentivize in-network care could lead to lower payments for out-of-network specialists. Actions that flout the intent of the No Surprises Act’s framework could lead to higher costs and lower-quality care for patients.