Seeking a Second Opinion: A Call for Congressional Evaluation of Anti-assignment Provisions in Employee Health Plans

By Jordan Davis

In the health insurance context, anti-assignment provisions are contractual clauses that restrict an insured individual’s ability to assign rights due under a health plan to another party, such as a medical provider. As these provisions have become increasingly prevalent in employersponsored health plan agreements, they have effectively stripped medical providers of enforcement and litigation rights previously utilized under the Employee Retirement Income Security Act of 1974 (ERISA)—the relevant federal regulation governing employee benefit plans, including health insurance plans.

This Note examines these effects in light of ERISA’s intended protections of employees participating in employer-sponsored benefit plans and considers whether congressional intervention is warranted to address the respective impacts as a result. This Note contends that while persuasive arguments exist both in support of a need for reform and for sufficiency of the status quo, arguments around these dueling views tend to draw on merely anecdotal evidence and theoretical economic contestations. Accordingly, this Note argues that Congress should develop empirical evidence to determine whether intervention is needed and proposes plausible long-term amendments to ERISA, should they be warranted, along with interim solutions to help address problematic impacts while such study is conducted.