The “Ghost Network” Problem: The Key Questions Employers Can Ask to Avoid Little-Known Benefits Risk
A recent federal district court decision highlights a little known but significant risk faced by employers with welfare benefit plans that rely on medical provider and facility networks supplied by insurance carriers or third-party administrators (TPAs). In Orrison v. Mayo Clinic , the US District Court for the District of Minnesota held that an employee adequately stated a claim against the employer plan administrator for maintaining an inaccurate database of medical providers. The September 19 decision means employer plan administrators may face possible liability in relying on the provider networks and related directories offered by insurance carriers and TPAs. What do you need to know about this decision, and what questions should you ask to monitor your plan’s network? The Facts In the Mayo Clinic case , an employee used an online search tool maintained by the TPA to find an available “in-network” mental health provider for her son. She alleged that the online too...