ILWU John Q Union Workers’ Strike over Medical Claim Denials Signaling U.S. Healthcare System Meltdown? ERISAclaim.com Provides Insights and Compliant Solutions
Hanover Park, IL (PRWEB) July 11, 2013 -- As the thousands of ILWU union workers in California went on strike or picketing on July 8, 2013 over medical claim denials or delays, as a result of the Union Plan anti-fraud initiatives, will this signal an US healthcare system meltdown felt by ILWU John Q? Will all coverage-denied John Q nationwide follow the uninsured John Q in Hollywood to bring the Congress or White House “under new management”? ERISAclaim.com announces unique insights and immediate practical compliant solutions to the ongoing ILWU medical claim crisis, for healthcare providers and health plans, to avoid John Q healthcare meltdown in the midst of PPACA implementation.
(·Long·Beach·Post,·July·8,·2013; http://www.lbpost.com/news/2000002550-hundreds-of-longshoremen-protest-over-medical-benefits#.Ud3FmW2YeVE )
Immediately available, ERISAclaim.com announces many new ILWU PMA Medical Claim Crisis Resolution programs, for healthcare providers, union representatives, benefits professionals and healthcare attorneys. These special ILWU Programs will review the most recent applicable federal court decisions on claim denials or delays in the context of antifraud initiatives for pre-service claims and post-service claims, DOL Amicus Brief in the 3rd Cir. Court, DOL Fiduciary Responsibility Compliance Guidelines, DOL ERISA Claims Regulation, ERISA Claims FAQ and Pre-service Claims Guidance, PPACA Claims Regulations, and step-by-step ERISA appeal practice for healthcare providers or patients for all ILWU PMA claim denials and delays, as well as the compliance assistance programs on how to file ERISA Complaints with DOL for compliance assistance and enforcement.
“While it’s extremely important to implement anti-fraud initiatives in healthcare industry today, it is also critical and paramount for every health plan to comply with all applicable federal laws, ERISA and PPACA claims regulations, as well as statutory fiduciary duties, for more than 170 million hard-working American workers and families. as well as statutory fiduciary duties, for more than 170 million hard-working American workers and families. When a needed chemotherapy is stopped for a dying cancer patient as claims delayed for 6 months or medical bankruptcy strikes most union members, Hollywood John Q will come to you or Washington D.C.,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert of ERISA compliance and appeals.
(·The·News·Tribune,·July·9,·2013; http://www.thenewstribune.com/2013/07/09/2670793/picket-addresses-longshore-medical.html )
“According to a new industry report on June 19, 2013, NerdWallet Health Estimates 56 Million Americans under 65 will Struggle with Medical Bills in 2013, and the medical bills are the No. 1 driver for personal bankruptcy in USA”, added Dr. Zhou.
http://www.nerdwallet.com/blog/health/2013/06/19/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/
“Simply put, the federal law, ERISA regulation, mandates for a pre-service claim decision and notification in 15 days, and additional 15 days if additional information is necessary but only requested within the first 15 days. A decision may be to pay or not to pay. A plan must comply with ERISA claims regulation, with or without fraud investigation according to the DOL Tri3 Amicus Brief”, demystified by Dr. Zhou.
“Every healthcare provider must comply with ERISA claims regulation, with an ERISA valid designation of authorized representative, before appealing a claim on behalf of any union member, as the Union Plan is a self-insured ERISA plan, not regulated under California state laws”, says Mr. Vincent Flores, a certified PPACA and ERISA Claim Specialist, co-founder of AVYM Corporation in Los Angeles, California. (http://avym.com/)
The new ILWU PMA Medical Claim Crisis Resolution and Compliance Programs will review and train:
(1) Step-by-step ERISA appeal practice for healthcare providers;
(2) Review of the most recent applicable federal court decisions on claim denials or delays in the context of antifraud initiatives for pre-service claims and post-service claims:
(a)Blue Cross & Blue Shield Of Rhode Island v. Jay S Korsen And Ian D Barlow, Case#: 109-Cv-00317, Filed 05/22/13, United States District Court for The District of Rhode Island.
http://www.prweb.com/releases/2013/5/prweb10763342.htm
(b)PENNSYLVANIA CHIROPRACTIC ASSOCIATION v. BLUE CROSS BLUESHIELD ASSOCIATION, Case: 1:09-cv-05619, United States District Court, N.D. Illinois, decided on October 12, 2012. http://www.prweb.com/releases/2012/10/prweb10044805.htm
(3) DOL Tri3 Enterprises Amicus Brief, supporting plaintiff-appellant http://www.dol.gov/sol/media/briefs/tri3-enterprises(A)-11-30-2012.htm#.UMfi5z9MHFo
(4) DOL ERISA FACT Sheet: Patients’ Rights Claims Procedure Regulation
(5) FAQs About The Benefit Claims Procedure Regulation.
(6) DOL: Understanding Your Fiduciary Responsibilities Under A Group Health Plan,
(7) ERISA & PPACA Claims Regulations
(8) Federal ERISA Prompt to Pay laws for precertification, pre-service claim and post-service claim
(9) Corporate Compliance Programs: Healthcare Fraud and Abuse Prevention, OIG Compliance Programs Guidelines
(10) How to file a Complaint with DOL: Request for Assistance from The Department of Labor, EBSA
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
Located in a Chicago suburb in Illinois, for over 13 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.
Jin Zhou, President, ERISAclaim.com, http://www.ERISAclaim.com, 630-808-7237, [email protected]
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