Insurer Largely Prevails In 9th Circuit ACA, ERISA Lactation Class Appeal

Mealey's (September 17, 2021, 1:39 PM EDT) -- SAN FRANCISCO — Nothing in the Patient Protection and Affordable Care Act (ACA) requires an insurer to cover out-of-network lactation services when if offers in-network care, which means that the named plaintiffs’ full-and-fair review claims under the Employee Retirement Income Security Act fail for lack of redressable injury, that the claims reprocessing class was properly rejected and that the judge improperly failed to look at the universe of communications in granting the denial letter class, a Ninth Circuit panel held Sept. 16....