With PPACA and ERISA compliance, out-of-network means out of trouble; without PPACA and ERISA compliance, out-of-network means out of luck for both patients and providers,
Hanover Park, IL (PRWEB) January 08, 2013
On Dec. 10, 2012, Federal DOL Bureau of Labour Statistics National Compensation Survey reveals that about 74% of all insured workers participating in medical care plans in private industry have out-of-network coverage in 2011. As a result, ERISAclaim.com announced its 2013 PPACA out-of-network claims specialist programs to advocate patient rights for choice of providers by compliance with all applicable federal and state laws.
These new PPACA out of network programs are specifically designed under new federal health reform law PPACA, Patient Protection and Affordable Care Act, with unprecedented patient protections, freedom of choice for providers, claims appeal rights, under PPACA and ERISA claims regulations, new 2013 PPACA SBC coverage disclosures, PPACA new definition of claimant to include out-of-network providers, and $14 billion in HSA for high deductible health plans (HDHP). All 74% of all insured Americans are protected under PPACA for high-quality and affordable care from the out-of-network providers.
On December 10, 2012, federal government, Department Of Labor (DOL) reports that 74% of all workers participating in medical care plans in private industry allow non-emergency services outside network (out-of-network coverage) in 2011, according to the December 2012 DOL Bureau of Labour Statistics National Compensation Survey: Health Plan Provisions in Private Industry in the United States, 2011.
For more detailed health insurance coverage information in private industry, download a copy of complete benefits bulletin:
PDF of Entire 2011 Benefits Bulletin: http://stats.bls.gov/ncs/ebs/detailedprovisions/2011/ownership/private/ebbl0051.pdf
The same DOL BLS survey reports that 71% of all workers participating in medical care plans in State And Local Government allow nonemergency services outside network in 2011.
For more detailed health insurance coverage information in the State and Local Government, download a copy of complete benefits bulletin:
PDF of Entire 2011 Benefits Bulletin: http://stats.bls.gov/ncs/ebs/detailedprovisions/2011/ebbl0049.pdf
“74% of out of network coverage in 2011 is slightly lower than 77% of out-of-network coverage in 2010, but more than 70% of insured Americans have paid for out-of-network coverage, that is the undisputed evidence for American workers’ choice of out-of-network quality care and freedom for providers,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA and PPACA compliance.
http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf (at page 11 of 167)
“In order to better advocate for the patient’s PPACA rights, an out-of-network provider must protect himself or herself first, to be licensed by his / her patient under PPACA to advocate for patient rights, or designated as an authorized representative on behalf of the patient,” explained Dr. Zhou.
The basic two-day Out-Of-Network Patient Rights Program will cover PPACA protections for patient freedom of choice under health plan provisions for out-of-network providers, new 2013 SBC (Summary of Coverage and Benefits) law mandates for out-of-network coverage disclosures, HSA (Health Saving Account) laws and $14 Billion in HSA for high deductibles and co-insurance.
The advanced six-day Out-Of-Network Claims Specialist Program will focus on PPACA and ERISA claims regulations and appeals for out-of-network claims and denials, medical necessity, usual, custom and reasonable (UCR), and all denials and delays for out-of-network providers, in addition to the basic two-day Out-Of-Network Patient Rights Programs.
The advanced eight-day Certified Out-Of-Network Claims Specialist Program will provide trainings on Corporate Compliance Policies - Fraud and Abuse Prevention, full & proper provider disclosures, to safeguard providers in advocating for patient ERISA / PPACA rights under federal law, 29 U.S.C. § 1141.
“With PPACA and ERISA compliance, out-of-network means out of trouble; without PPACA and ERISA compliance, out-of-network means out of luck for both patients and providers,” added Dr. Zhou.
ERISAclaim.com out-of-network programs advocate for provider proper disclosures, including but not limited to:
1. PPACA discount policy
2. An estimated charge for each service
3. An estimated charge for all services
4. Network participation status
5. Billing and collection policies
6. Referring provider affiliation and remuneration arrangement, if any
7. PPACA/ERISA appeal assistance
8. Guaranteed Patient Satisfaction (GPS) statement for total disclosure and transparency.
To find out more services and products 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 ERISA claims” for healthcare providers.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.