The Client:

A large Pennsylvania medical center.

 

The Situation:

An insured patient was given life-saving treatment at more than $450,000. Though the hospital appropriately sought payment from the patient’s employer-sponsored health plan, the plan failed to pay.  When the hospital sued, the plan moved to dismiss the case, arguing ERISA preempted the suit and provided the only remedies available, which would have effectively shut out the hospital from receiving any payment.

 

The Chartwell Solution:

Against the weight of Supreme Court precedent and what seemed to be clear language in the statute, Chartwell argued that ERISA did not apply to this situation and that it is exclusively a function of the employment relationship.  After extensive briefing and argument, the federal court sitting in Philadelphia agreed.  Chartwell is now pursuing the $450,000 on behalf of the hospital.