cmonfils | January 5, 2012
www.myhealthguide.com
MyHealthGuide Source: The Phia Group, 12/31/2011
Editor’s Note: Last week (and again below), this Newsletter reported that The Self-Insurance Institute of American (SIIA) filed an Amicus Brief on behalf of GPA Holding, Inc. in the case, GPA Holding, Inc. v. Baylor Health Care System. The Texas Supreme Court has now responded.
The Texas Supreme Court has requested an answer from Baylor in response to the Amicus Brief filed by SIIA. This indicates a greatly improved likelihood that the Court will hear the appeal. Evidently, the issues raised in SIIA’s brief, as well as briefs filed by the petitioner and other organizations, worried the Court enough to examine the lower court’s decision.
“This is a positive development in that Court has taken our briefs very seriously and is now forcing Baylor to respond before making a decision whether or not to take the case,” says Mike Ferguson, SIIA’s Chief Operating Officer.
At issue is whether third party administrators (TPAs) can be held financially liable for health care services incurred by self-insured group health plan participants. The lower courts (trial and appeal) declared that such financial liability is lawful, relying solely upon a one-sided interpretation of the applicable PPO agreement’s terms.
SIIA’s brief, drafted by attorneys Adam Russo and Ron Peck of The Phia Group, LLC, argues that such legal interpretation requires that TPAs be deemed plan fiduciaries (as only fiduciaries may be responsible for usage of plan assets), which clearly conflicts with the Employee Retirement Income Security Act (ERISA).
More broadly, SIIA contends that the Appeals Court decision threatens the existence of TPAs in Texas and elsewhere, and in turn, would greatly compromise the viability of self-insured group health plans for most employers eliminating one of the most cost efficient, and effective methods for providing robust health benefits to Americans.
Category: News, Texas, Third Party Administrators |
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