ObamaCare Overpayment Laws: Court Ordered BCBS to Offer ERISA EOB and Appeals - ERISAclaim.com Demystifies
Hanover Park, IL (PRWEB) April 09, 2014 -- On March 28, 2014, a federal ERISA court ordered BCBS IBC to offer strict ERISA EOB (Explanation of Benefits) and full and fair appeals, as a result of a provider overpayment class-action. Today ERISAclaim.com announced new comprehensive ERISA and PPACA Overpayment Appeal and Litigation Support Programs in accordance with the most recent federal court decisions. ERISAclaim.com will demystify new ObamaCare ERISA & PPACA overpayment laws, although under a 39-old federal ERISA law, but now adopted in its entirety by ObamaCare (PPACA) for all health plans.
Case Info: Pennsylvania Chiropractic Association, et al. vs Blue Cross Blue Shield Association, et al., Case: 1:09-cv-05619 Document #: 912 Filed: 03/28/14, in the United States District Court for the Northern District of Illinois Eastern Division
ERISAclaim.com provided the plaintiff providers with ERISA appeal compliance and ERISA litigation support in this provider ERISA class action.
In this landmark decision against a BCBS entity, Independence Blue Cross (IBC), “For these reasons, this Court finds that the notice that IBC provides to PCA members from whom it is recouping payments does not substantially comply with ERISA.” according to the court documents. …the Court finds in favor of PCA on its claims against IBC and concludes that PCA is entitled to an appropriate permanent injunction. … The court concludes that IBC's practices come nowhere near substantial compliance with ERISA's notice and appeal requirement.” according to the court documents.
“Since March 23, 2010, ERISA claim regulation has been adopted in its entirety into ObamaCare, Patient Protection and Affordable Care (PPACA), for all health plans and individual policies, for both ERISA and non-ERISA plans, and the epidemic overpayment dispute has been the No. 1 health care claim denial in the past 10 years”, says Dr. Jin Zhou, pres. of ERISAclaim.com, a national expert on ERISA and PPACA compliance, for overpayment appeals.
“For the first time in US healthcare history, the new federal overpayment recoupment laws are evolved rapidly, when a federal court ordered permanent injunctions against BCBS entities, in the wake of several recent federal court class-action decisions in favor of the providers”, explains Dr. Zhou.
“Permanent injunction: The evidence showed that it has been IBC's usual course of business to provide inadequate notice and appeal rights in connection with recoupments of payments from PCA's members. The injuries at issue are irreparable, and PCA's members lack an adequate remedy at law to redress them….Finally, requiring a plan administrator to afford notice and appeal rights that comply with ERISA serves the public interest in enforcing duly enacted national legislation whose purpose is to protect workers who are the direct beneficiaries of employer-provided health and welfare benefit plans.” according to the court documents.
In demystifying this landmark class-action permanent injunction decision, ERISAclaim.com will also offer advanced training on ERISA and PPACA overpayment appeal practice and compliance, specifically in accordance with Department of Labor (DOL)’s regulatory interpretation of ERISA claim regulations governing all overpayment disputes, Retroactive Adverse Benefit Determination (RABD):
“The crux of the question at issue here is not whether the plaintiff or the defendant is correct in their views of the plan terms, but whether Aetna must comply with the procedures mandated by ERISA … In either event, Tri3 is entitled to insist upon its assigned right to challenge the allegedly wrongful decision to deny benefits through a process that complies with the claims regulation.” according to DOL Tri3 Enterprises Amicus Brief, supporting plaintiff-appellant, TRI3 ENTERPRISES, LLC, v. AETNA, Inc.
http://www.dol.gov/sol/media/briefs/tri3-enterprises(A)-11-30-2012.htm#.UMfi5z9MHFo
ObamaCare (PPACA) compliance mandate inspired ERISAclaim.com’s new comprehensive ERISA and PPACA Overpayment Appeal and Litigation Support Programs:
“SUMMARY: This document contains interim final regulations implementing the requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets under the Patient Protection and Affordable Care Act. The regulations will generally affect health insurance issuers; group health plans; and participants, beneficiaries, and enrollees in health insurance coverage and in group health plans. The regulations provide plans and issuers with guidance necessary to comply with the law. DATES: Effective date. These interim final regulations are effective on September 21, 2010.” according to PPACA regulations for Internal Claims and Appeals and External Review.
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056
“(i) Minimum internal claims and appeals standards. A group health plan and a health insurance issuer offering group health insurance coverage must comply with all the requirements applicable to group health plans under 29 CFR 2560.503–1 …. with respect to health insurance coverage offered in connection with a group health plan, the group health insurance issuer is subject to the requirements in 29 CFR 2560.503–1 to the same extent as the group health plan.” according to PPACA regulations for Internal Claims and Appeals and External Review.
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056
To find out more about ERISA & PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
Located in a Chicago suburb in Illinois, for over 14 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, ERISAclaim.com, http://www.ERISAclaim.com, +1 630-808-7237, [email protected]
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