PPACA & ERISA: New “Federal Department Of Insurance (DOL)” Responds To Complaints in 3 Business Days

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New PPACA & ERISA Enforcement, In The Wake Of The Supreme Court’s New Decision: The New DOL Complaint Webpage Will Respond To Complaints In 3 Business Days. ERISAclaim.com Offers Webinars And Workshops On How To Get Paid By Being Compliant When Making DOL Complaints.

The ‘Federal Department of Insurance (DOL)’ may help you in 3 business days when the State Department of Insurance (DOI) could not in 3 years, because the State DOI doesn’t have jurisdiction over the ERISA claims.

As a part of new PPACA & ERISA enforcement in 2012, and in the wake of the Supreme Court’s new decision, CIGNA v. Amara (No. 09–804), the U.S. Department of Labor (DOL) created a new Consumer Complaint Webpage on Nov. 10, 2011. The DOL will respond to complaints, in 3 business days, against health plans for improperly denied health claims. The various PPACA & ERISA informed providers of ERISAclaim.com have seen the most effective, responsive and timely DOL enforcement and investigations into the alleged wrongful claim denials. ERISAclaim.com offers new Webinars and workshops to assist healthcare providers in understanding the new healthcare reform laws, PPACA claims regulations, being fully enforced in 2012 by the federal “Department of Insurance” (DOL), and effective and compliant filing of Complaints with DOL for all improperly denied health claims, in order to get paid quickly at the minimum costs.

The next ERISAclaim.com ERISA & PPACA DOL Complaint Program will be held on Jan 23 & 24, 2012 in the greater Houston area, Texas in private sessions.

“The ‘Federal Department of Insurance (DOL)’ may help you in 3 business days when the State Department of Insurance (DOI) could not in 3 years, because the State DOI doesn’t have jurisdiction over the ERISA claims, for both self-insured and fully-insured health plans,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

In accordance with the Supreme Court’s new decision in CIGNA v. Amara, the DOL filed a Kenseth Amicus Brief (No. 11-1560) in support of patient, argued that “CIGNA has dramatically changed the legal landscape” of managed care industry, because ERISA now provides patients with “the make-whole remedy of surcharge and other equitable monetary awards under ERISA section 502(a)(3)”. (http://www.dol.gov/sol/media/briefs/kenseth(A)-6-13-2011.htm)

To enforce the new ERISA after Cigna v. Amara, and the PPACA as healthcare reform laws, a DOL News Release on Nov. 10, 2011 announced the new Consumer Assistance / Compliant Web Page. (http://www.dol.gov/opa/media/press/ebsa/EBSA20111627.htm)

"Helping retirement and health plan participants find answers to questions about their benefits and providing assistance when they believe their benefits have been improperly denied is one of our most important responsibilities," said EBSA Assistant Secretary Phyllis C. Borzi. "The new consumer assistance Web page and electronic inquiry/complaint process will provide quick answers to the most frequently asked questions and connect workers to experienced benefits advisers if assistance is needed."

“The page includes links to various tools and publications with information on benefit plans, as well as answers to questions about "hot topics." Users also have the option to submit a question, file a complaint or report a problem with their plan. Inquiries and complaints submitted are sent directly to EBSA benefits advisers, who will respond as soon as possible but no later than three business days. Additionally, the system automatically routes the requests to the appropriate EBSA regional office based on users' ZIP codes.”

In 2010 alone, DOL EBSA has helped 230,000 consumers and obtained more than $478 millions in benefits that had been wrongly denied to 173,000 participants.

“DOL response time of 3 days should inspire providers to use the Consumer Complaint Webpage”, says Mark Flores, a certified PPACA & ERISA Claim Specialist, Director of Healthcare Revenue & Consulting, YF Corporation in Los Angeles, CA.

ERISAclaim.com will demystify the most important steps for successful DOL Complaints for wrongfully denied claims: (1) Become a PPACA Claimant with valid designation of authorized representative (DAR). Your traditional assignment of benefits (AOB) may be limited or insufficient; (2) Get your facts straight; (3) first submit timely WRITTEN appeals under PPACA & ERISA; (4) then file DOL Complaint with clear facts, focusing on the specific plan / payer’s violations of PPACA & ERISA regulations, avoid arguing medical or coding merits, as DOL doesn’t decide medical necessity or billing and coding disputes; (5) Complain against both TPA and Plan Administrator.

ERISAclaim.com ERISA & PPACA DOL Complaint Programs are immediately available and will cover the following topics:

1.    EBSA News Release: US Department of Labor’s EBSA creates new consumer assistance Web page [11/10/2011] http://www.dol.gov/opa/media/press/ebsa/EBSA20111627.htm
2.    "Federal Department Of Insurance Complaints Website" for Doctors and Patients: https://www.askebsa.dol.gov/WebIntake/Home.aspx?submit=Submit+a+Complaint
3.    PPACA claims regulation, effective September 23, 2010, being fully enforced in 2012 (http://www.dol.gov/ebsa/healthreform/)
4.    How to identify a real plan administrator according to DOL document;
5.    How to identify PPACA and ERISA violations in claims denials and delays.
6.    How to file Effective, compliant DOL complaint for all wrongly denied and delayed claims.
7.    U.S. GAO, (GAO-11-268 March 16, 2011) (http://www.gao.gov/products/GAO-11-268): “Ohio data indicated that 0.5 percent of claim denials were internally appealed.”

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.


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