Failure to recognize this historical out-of-network avalanche will result in shocking financial disasters, says Dr. Jin Zhou
Hanover Park, IL (PRWEB) February 07, 2012
ERISAclaim.com offers new Executive Webinars to examine Aetna's “$66,100 Bunion Surgery” lawsuit against seven California surgery centers, filed on 02/02/2012 in the state court, seeking to stop the alleged UCR billing without collecting full deductible and coinsurance from all patients. This new Aetna lawsuit is filed in California after Aetna’s other similar lawsuits in other parts of the county, such as TX, seeking for the court injunction to stop the alleged fraudulent hospital and surgeons' UCR billing without collecting full deductible and co-insurance from all patients. Aetna may or may not prevail in the court for these allegations, but these health plan litigations have definitely created a new chapter in U.S. healthcare history for all out-of-network healthcare delivery and reimbursement, for 77% of Americans with out-of-network coverage and insured through private employer-sponsored plans, and governmental plans as well as individual markets.
The new Executive Webinars will provide in-depth evaluation of these new out-of-network litigations, and discuss practical solutions through proactive compliance and appeals in accordance with applicable federal or state laws for all healthcare providers delivering quality care to all patients who paid for expensive out-of-network coverage.
The court case info: Aetna Life Insurance Co. v. Bay Area Surgical Management LLC, File 02/02/2012, Case #: 112CV217943, The Superior Court of California, County of Santa Clara.
Aetna TX case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152), Harris County, Texas.
“Failure to recognize this historical out-of-network avalanche will result in shocking financial disasters, as experienced by so many hospitals in 2003, faced with class actions by patients in almost all 50 states and most State Attorney Generals for alleged Hospital “Price Gouging”, when the hospitals were aggressively collecting full charges from uninsured and underinsured patients,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
“History is repeating itself,” explained Dr. Zhou, by referring to the Feb. 19, 2004 Letter From Tommy G. Thompson, then Secretary of Health and Human Services, To Richard J. Davidson, then President, American Hospital Association, , http://archive.hhs.gov/news/press/2004pres/20040219.html
According to the Court document, Aetna sued two healthcare executives, one management company and seven surgical centers.
In the court complaint, Aetna seeks to stop these out-of-network surgical centers from waiving the deductible and co-insurance payments in order to allegedly illegally lure or induce the patients, then billing Aetna for alleged inflated UCR fees, up to 2,500% more than Aetna's PPO discounted rates. Aetna accused these surgical centers of allegedly “recklessly subverts” health care delivery with charges of as much as $66,100 for a bunion repair, according to the plaintiff’s complaint.
In the Court, the Aetna seeks to permanently stop the alleged out-of-network UCR billing without collecting full deductible and coinsurance from all patients.
The “scheme must be promptly declared illegal to preclude its continuation and replication throughout California, and to avoid the potential consequences of irreparably damaging a system of healthcare delivery on which millions of citizens rely,” according to the plaintiff’s complaint filed with the Court.
Aetna may or may not prevail in the court of law with these allegations. But meanwhile, what are we supposed to do if we have 77% of insured Americans in private sector who paid for the expensive out-of-network premiums for coverage but now can't afford to pay 100% of escalating deductibles and coinsurance? asked Dr. Zhou.
According to a New York Times report on January 26, 2012: “Health Insurance Deductibles Doubled in 7 Years, Study Finds - If you’ve seen your health insurance premiums increase along with your deductible, you’re not alone.” (http://bucks.blogs.nytimes.com/2012/01/26/family-health-insurance-costs-doubled-in-7-years-study-finds/)
According to CNN back in 2009, “Medical bills prompt more than 60 percent of U.S. bankruptcies”. (http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH)
“Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance” (http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm)
The ERISAclaim.com’s Executive Webinars will cover the following topics:
1. Aetna and other payers UCR litigations have changed the U.S. out-of-network healthcare history with respect to health care delivery and reimbursement for 2012 and ever.
2. Practical impacts of the payers’ litigations on all out-of-network patients, doctors, ASC’s and hospitals.
3. Compliant solutions, from OIG Guidance, to all alleged fraud and abuse preventions
4. DOL: About 77% of Insured Americans Purchased Out-Of-Network Coverage in Private Industry (BLS, NBS 2010, page 11 of 167): http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf
5. PPACA Claims Regulations and Guidance from DOL: http://www.dol.gov/ebsa/healthreform/
6. PPACA & ERISA Claims Regulations Assistance and Complaints Webpage from DOL:
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, 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.