PPACA SBC: New Federal “Insurance Verification” Laws - “One Nation, One Standard” For All Patients & Providers

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On February 9, 2012, HHS, IRS & DOL Announced New PPACA SBC Final Rule, Traditionally Known As "Insurance Verification” Law For Both In And Out-Of-Network Providers. Effective Sep. 23, 2012, “One Nation, One Standard” For Coverage Disclosures. ERISAclaim.com Offers Webinars on This New Chapter of Patient and Provider Protections.

Healthcare industry will no longer be under 'Don't Ask, Don't Tell” Policy for patient coverage verification.

On February 9, 2012, HHS, IRS & DOL announced new federal PPACA SBC (Summary of Benefits & Coverage) Final Rule, traditionally known as "Insurance Verification” law or “mini-SPD” (Summary Plan Description) law, for 150 million Americans with private health insurance. The SBC Final Rule will govern both in-network and out-of-network providers and hospitals. Effective on Sep. 23, 2012, the nation will be under “One Nation, One Standard” policy for the insurance coverage verification and disclosures. ERISAclaim.com offers new Executive Webinars on this new chapter of patient and provider protections under the new healthcare reform law, Patient Protection and Affordable Care Act (PPACA). This new federal PPACA SBC law will change U.S. healthcare history in the ways how every healthcare decision is made by patients, doctors and hospitals, with respect to accurate insurance coverage verification for both in and out-of-network health care services. This new SBC law also eliminates discrimination against out-of-network health care providers.

“Say goodbye to the days when you were given inaccurate coverage information and ‘payment-not-guaranteed’ disclosure from an insurance company, or no coverage verification at all for the out-of-network providers on the patient initial visit. Under this new federal PPACA SBC law, a mini version (4 pages) of the insurance policy must be disclosed in a single federal standard to every patient and provider regardless of network participation,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

“Healthcare industry will no longer be under 'Don't Ask, Don't Tell” Policy for patient coverage verification. The new federal law, with "One Nation, One Standard” and mandatory "No Ask, Must Tell”, will save not only hundreds of millions of dollars for every one but also reduce administrative headaches for healthcare providers,” explains Dr. Zhou.

According to the HHS Press Release on February 9, 2012, “Health Reform to Require Insurers to Use Plain Language in Describing Health Plan Benefits, Coverage” (http://www.hhs.gov/news/press/2012pres/02/20120209a.html):

“The marketing materials that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying. The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage. The new rules will also make it easier for people and employers to directly compare one plan to another.

“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

Under the rule announced today, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations, which will be available beginning, or soon after, September 23, 2012 will be a critical resource for the roughly 150 million Americans with private health insurance today.”

For more information on the rules announced today, visit: http://www.healthcare.gov/news/factsheets/2011/08/labels08172011a.html

“With the exception of charity care, this is extremely important for every healthcare provider and hospital in the Nation and creates fundamental changes in the way every health care decision is made by both patients and providers,” said Vincent Flores, a certified PPACA and ERISA Claim Specialist, VP of YF Corporation in Los Angeles, California.

The PPACA & ERISA Claim Specialist Webinar will cover the following topics:

New federal PPACA SBC (Summary of Benefits and Coverage) Laws and Uniform Glossary

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:

Located in a Chicago suburb in Illinois, for over 12 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 PPACA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.


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