Case: Health Care & Benefits/Underpayment (E.D.N.Y.)

A federal district court in New York denied UMR Inc.'s motion for summary judgment and granted a physician summary judgment on his action on behalf of a patient, alleging underpayment of healthcare benefits in violation of ERISA. The court determined that UMR must interpret “usual and customary” on remand based on the prevailing market rates for the procedure in the relevant geographical area.