5th Circuit Reverses Judgment, Says Health Plan's Terms Ambiguous

5th Circuit Reverses Judgment, Says Health Plan's Terms Ambiguous

NEW ORLEANS - In an unpublished opinion, a Fifth Circuit U.S. Court of Appeals panel on May 31 reversed a lower court's decision granting summary judgment in favor of a health insurer in a wrongful denial of benefits case, saying that plan terms were ambiguous as to when preauthorization for services provided by an out-of-network provider were required (Nancy Koehler v. Aetna Health Inc., No. 11-10458, 5th Cir.; 2012 U.S. App. LEXIS 11190).

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