No. 20-73

IV Solutions, Inc. v. PacifiCare Life & Health Insurance Co.

Lower Court: Ninth Circuit
Docketed: 2020-07-27
Status: Denied
Type: Paid
Response Waived
Tags: claim-reprocessing dialogue explanation-of-benefits health-care-provider health-insurance-company healthcare-provider insurance-claims legal-interpretation statute-of-limitations
Key Terms:
JusticiabilityDoctri
Latest Conference: 2020-09-29
Question Presented (AI Summary)

When does the statute of limitations begin running for a health care provider's claims against an insurance company?

Question Presented (OCR Extract)

QUESTION PRESENTED When a health care insurance company issues an Explanation of Benefits (““EOB”) expressly inviting a health care provider to “notify it of additional information clarifying the services and/or charges,” and thereafter engages in an extended dialogue with the health care provider regarding the reprocessing of the provider’s claims in light of such additional information, does the statute of limitations begin running as a matter of law immediately upon the issuance of that Explanation of Benefits, even though the insurance company, through its representatives, thereafter communicated to the provider on numerous occasions that the provider’s claims were still being reviewed and reprocessed?

Docket Entries

2020-10-05
Petition DENIED.
2020-08-19
DISTRIBUTED for Conference of 9/29/2020.
2020-08-11
Waiver of right of respondent Pacificare Life & Health Insurance Company to respond filed.
2020-07-17
Petition for a writ of certiorari filed. (Response due August 26, 2020)

Attorneys

IV Solutions, Inc.
Marc E. RohatinerWolf, Rifkin, Shapiro, Schulman & Rabkin, LLP, Petitioner
Pacificare Life & Health Insurance Company
Emily Tomoko Barner KuwaharaCrowell & Moring LLP, Respondent