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11th Circuit: External Medical Necessity Review Not Binding On Parties

Mealey's (August 17, 2016, 1:18 PM EDT) -- ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Aug. 16 held that a federal judge erred in determining that an external review of the medical necessity of a woman’s anorexia treatment was binding on the parties and precluded her from challenging Oxford Health Insurance Inc.’s denial of her claim under the Employee Retirement Income Security Act because the external review had not finally decided the issue against her (Alexandra H. v. Oxford Health Insurance Inc. Freedom Access Plan, et al., No. 15-11513, 11th...
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