The federal Courts of Appeals are expected to make these landmark decisions in the next a few months for the market lifespan of the out-of-network and managed care business model,” says Dr. Zhou.
Hanover Park, IL (PRWEB) May 01, 2014
On April 7, 2014 and April 28, 2014, Obama administration, Department of Labor (DOL), argued in the 9th and 5th Circuit Courts, for out-of-network providers and patients against the health plans, on whether providers must first balance bill patients before billing health plans. ERISAclaim.com demystifies, through its new ERISA and PPACA seminars, the court impacts of the DOL amicus briefs and oral arguments for all out-of-network healthcare providers and patients. Approximately 76% of insured Americans through their employer-sponsored health plans have paid for out-of-network coverage, according to the December 2013 National Compensation Survey from DOL Bureau of Labor Statistics.
ERISAclaim.com closely monitors and demystifies the latest federal court developments for all out-of-network patient advocates and claims specialists, with new ERISA and PPACA reimbursement compliance seminars.
“The court rulings from both 9th and 5th Courts of Appeals will have profound impact on approximately 76% of the insured Americans under the employer-sponsored health plans, as they have paid for out-of-network coverage, but may not be able to first pay for their full deductible and coinsurance before seeking for timely vital healthcare,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA and PPACA compliance appeals.
Despite having year-round in-network insurance coverage with PPO discount in 2013, 56 million Americans are struggling with medical bills, with skyrocketing medical bankruptcies, according to a NerdWallet Health report in 2013, says Dr. Zhou.
Spinedex Physical Therapy USA, et al v. United Healthcare of Arizona, et al, Case No. 12-17604, in the United States Court of Appeals for the Ninth Circuit, on April 7, 2014
Oral argument recording: http://cdn.ca9.uscourts.gov/datastore/media/2014/04/07/12-17604.wma
Spindex Physical Therapy USA, Inc. Amicus Brief, in support of plaintiffs-appellants and requesting reversal
North Cypress Medical Center, et al v. Cigna Health, Case No. 12-20695, in the United States Court of Appeals for the Fifth Circuit, on April 28, 2014
Oral argument recording: https://www.ca5.uscourts.gov/OralArgRecordings/12/12-20695_4-28-2014.wma
North Cypress Medical Center Operating Co. Amicus Brief, in support of plaintiffs-appellants, and requesting reversal
Among other things, in arguing for out-of-network providers’ right to sue ERISA plans without first collecting full deductible and coinsurance from patients, “Assignee physicians with validly assigned benefits claims have standing to pursue those claims regardless of whether or not if they first billed their patients,” argued Marcia Elizabeth Bove, DOL attorney for the Secretary of Labor, according to the court audio records.
In arguing for out-of-network patients for their timely vital healthcare without having to first pay full deductibles and coinsurance, Obama administration argued against the current out-of-network claim denial practice by United and CIGNA:
“Thousands of healthcare claims are made in this country every day, and some are litigated, and yet no circuit court has ruled that providers must first bill their patients before they may enforce legitimately assigned benefits claims. …. Limiting physicians’ first recourse to their patients will have chilling effects both on providers and plan participants. Participants may forgo or delay vital healthcare because they cannot finance or they cannot pay for their care, and providers may limit their care to those participants whose health plans have previously paid properly assigned healthcare claims or participants who are able to first to pay for the care, or the provider can recognize as creditworthy. Affirmance of the district court ruling can only benefit conflicted administrators, such as United, that both fund and administrator ERISA plans, by allowing them to forestall payments for substantially expensive medical care or maybe avoid that payment altogether”, according to the court audio records.
“By listening to the arguments from both sides of the healthcare matrix, out-of-network providers and patients may have much better understanding on the vital difference between patients, providers and health care plans. The federal Courts of Appeals are expected to make these landmark decisions in the next a few months for the market lifespan of the out-of-network and managed care business model,” says Dr. Zhou.
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
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.