on May 16, 2011, Supreme Court significantly redefined ERISA with new remedies and protections for patients and providers by its decision in Cigna v. Amara.
Hanover Park, IL (PRWEB) December 31, 2011
ERISAclaim.com announces 2012 Webinars on Patient's (Doctor’s) Bill Of Rights under health reform laws for claims denials, delays and overpayment crisis. PPACA claims regulations will be fully enforced in 2012 by adopting 36-year-old federal law, ERISA, in its entirety with new protections for patients, doctors and hospitals. PPACA & ERISA Outlaws 36-year-old discriminative anti-assignment practice by all insurance companies and managed care entities, with a new definition of claimant under PPACA, making all doctors and hospitals with valid PPACA and ERISA assignments equally protected under PPACA, also known as “Doctor's Bills of Rights”, regardless of providers PPO network participation. ERISAclaim.com’s Doctor’s Bill of Rights Webinars starts at $5,000 for each two-hour session for each organization.
On November 10, 2011, for the first time in U.S. healthcare history, as a part of PPACA enforcement, federal government launched a "Federal Insurance Department Website" for both patients and providers. On March 16, 2011, Congressional GAO published a report indicating that less than 0.5% of denied claims were appealed in the State of Ohio while 39 to 59% of appeals reversed denied claims.
“While Supreme Court is scheduled in March 2012 to review the constitutionality challenge on PPACA, on May 16, 2011, the Court significantly redefined ERISA with new remedies and protections for patients and providers by its decision in Cigna v. Amara (Case #: 09–804). Regardless of the Supreme Court decision on individual coverage mandate, PPACA claims regulation is completely based on ERISA claim regulation, the 36-year-old federal law, completely governing all employer-sponsored health plan claims," said says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
According to DOL data, about 77% of insured Americans under employer-sponsored plans have purchased out-of-network coverage by paying higher premiums, out of network doctors and hospitals are completely powerless without PPACA and ERISA compliance if any patients wanted to exercise their rights to see out-of-network doctors and hospitals, warned Dr. Zhou.
ERISAclaim.com’s “Doctors’ Bill of Rights Webinars” will cover following topics with in-depth analysis and compliance of PPACA and ERISA ($5,000/2 Hr session/private only):
1. PPACA “Patient’s Bill of Rights” aka “Doctors’ Bill Of Rights:
“On June 22, 2010, President Obama announced new interim final regulations, the Patient’s Bill of Rights, that include a set of protections that apply to health coverage starting on or after September 23, 2010, six months after the enactment of the Affordable Care Act.”
2. DOL Affordable Care Act Regulations and Guidance: http://www.dol.gov/ebsa/healthreform/
3. PPACA Regulations on Internal Claims and Appeals and External Reviews:
4. EBSA News Release: US Department of Labor’s EBSA creates new consumer assistance Web page [11/10/2011]
5. "Federal Department Of Insurance Complaints Website" for Doctors and Patients: https://www.askebsa.dol.gov/WebIntake/Home.aspx?submit=Submit+a+Complaint
6. Congressional GAO Reports: 39% to 59% denial reversal with valid appeals, only 0.5% appeals in Ohio - http://www.gao.gov/new.items/d11268.pdf
7. DOL: About 77% of Insured Americans Purchased Out-Of-Network Coverage under Private Industry (DOL, BLS, NBS 2010, page 11 of 167): http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf
8. How to become a compliant claim expert in Doctor’s Bill Of Rights under PPACA and ERISA, to appeal all wrongful denials and delays for medical necessity, policy limitation, billing coding errors and out-of-network choices and a direct insurance payment.
In addition, ERISA Outlawed anti-assignment practice since January 1, 2003:
"The proposal eliminated a provision in the 1977 regulation that seemed to imply that representatives of a claimant must be ``duly authorized'' to act on behalf of the claimant. This change reflected the perception of the Department that no single Federal standard governs the authorization of a representative and that claimants should be able to freely name representatives to act on their behalf…..Specifically, subparagraph (b)(4) provides that a plan's claims procedures may not preclude an authorized representative (including a health care provider) from acting on behalf of a claimant and further provides that a plan may establish reasonable procedures for verifying that an individual has been authorized to act on behalf of a claimant. …\36\ This provision, which is a clarification of current law, applies to all employee benefit plans covered under the Act.”
Most importantly, PPACA “Doctor’s Bill Of Rights” redefined "Claimant" for equal protections under Patient's Bill of Rights:
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056 (page 43355)
“(iii) Claimant. Claimant means an individual who makes a claim under this section. For purposes of this section, references to claimant include a claimant’s authorized representative.”
To find out more about the Total PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 11 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.