rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill.
Hanover Park, IL (PRWEB) April 5, 2010
ERISAclaim.com announced special coverage of its free webinars to discuss recent Obama health reform law for out-of-network non-participating provider's rights to directly receive insurance reimbursement checks with valid ERISA assignment of benefits and non-discrimination protections regardless of non-participation. Patient Protection and Affordable Care Act, PPACA, went into effect upon the enactment of the act on March 23, 2010. PPACA incorporates or adopts existing federal law, ERISA, for all group and individual health plans to mandate unconditional acceptance of valid patient assignments for disbursement of reimbursement checks directly to the designated health care providers regardless of their network participation. A recent United States Supreme Court ruling ordered ERISA plan administrators to disburse benefits solely based on plan document and valid assignment instead of any external documents. About 70% of insured working Americans paid higher premiums for out-of-network coverage and rights to see nonparticipating providers on UCR fee schedules.
ERISAclaim.com has been offering free webinars on new health reform laws for doctors and hospitals since the House of Representatives passed its version of health care reform bills in last November. Due to the overwhelming reception from the webinar attendees and increasing demand from non--participating providers for such topics, as result of recent announcement from many major insurance companies that no insurance reimbursement checks will be sent to out-of-network providers.
The webinars will cover very specific provisions, §2719 and §2706, of new healthcare reform law, Patient Protection and Affordable Care Act, PPACA, in reference to mandatory compliance with the established ERISA claim regulation in its entirety, ERISA §2560.503-1 for every group health plan an individual plan. ERISA §2560.503-1 (b)(4) prohibits any anti-assignment practice and discrimination by any group health plan in refusing to disburse benefits checks with valid patient assignments. Department of Labor, DOL, issued enforcement guidelines, DOL ERISA FAQ, B3, in explaining plan administrator's fiduciary duties in compliance with ERISA assignment requirement. United States Supreme Court ruled on January 26, 2009 in Kennedy v. Plan Administrator for DuPont that ERISA plan administrators must make benefits determination and benefits disbursement decisions solely based on plan documents and valid participant assignment.
According to Dr. Jin Zhou, president of ERISAclaim.com, a national ERISA expert, and reimbursement compliance consultant, it is increasingly popular from industry existing practice that health care providers historically ignored these protections from federal law, ERISA, in failing to secure valid ERISA Legal Assignment for Benefits from their patients, therefore insurance companies and health plans will have no obligations to any health care providers in absence of valid ERISA assignments, in accordance with DOL claim guidelines, ERISA FAQ, B2. On the other hand, if with a valid ERISA assignment, and an insurance company or health plan must send reimbursement checks directly to healthcare providers as a designated and authorized representative, regardless of network participation, pursuant to DOL ERISA FAQ B3. Dr. Zhou also explained ERISA claim regulation has outlawed industry anti-assignment practice since January 2003.
Patient Protection and Affordable Care Act, PPACA, specifically prohibits any discrimination against any health care providers regardless of network participation:
`SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.
`(a) Providers- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law.
As President Barack Obama explained the new PPACA and ERISA Appeals on Jan 09, 2010 in his weekly address:
"And there will be a new, independent appeals process for anyone who feels they were unfairly denied a claim by their insurance company.
In short, once I sign health insurance reform into law, doctors and patients will have more control over their health care decisions, and insurance company bureaucrats will have less. All told, these changes represent the most sweeping reforms and toughest restrictions on insurance companies that this country has ever known."
According to New York Attorney General Andrew M. Cuomo on January 13, 2009, about 70% of insured working Americans paid higher premiums for out-of-network coverage and providers. It is a matter of national economic social security for working American families if they will get the benefit as promised, said Dr. Zhou.
"In February 2008, the Attorney General announced an industry-wide investigation into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. Seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the "usual and customary" rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill."
New free webinars are a part of continued efforts from ERISAclaim.com on a weekly and monthly basis to help all involved with very specific and accurate statutory provision reviews and discussions on all new Obama health law mandates for claim appeals. The time for each free webinar is 60 minutes, from 11 AM to 12 PM, or 1 PM to 2 PM, Central Standard Time. Registration is free for all. The Webinar Handout is also available and free to download at: http://www.erisaclaim.com/Free_ERISA_Webnars.htm.
In the past 10 years, ERISAclaim.com has been the only ERISA Specialized Company offering the most practical and comprehensive ERISA education, consulting and publishing services for healthcare providers in administrative ERISA appeals for real problem oriented denials under the most mysterious 35-year-old federal law, ERISA. Dr. Jin Zhou, president ERISAclaim.com has been regarded as the Godfather of ERISA claims for healthcare providers by some in Professional billing and coding industry.
For more information or to arrange an interview, please contact Dr. Jin Zhou, president of ERISAclaim.com at 630-808-723 or visit: http://www.erisaclaim.com/Free_ERISA_Webnars.htm