BCBS Ordered to Permanently Reform Its Overpayment Policies in Provider Class Action - ERISAclaim.com Demystifies

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On May 19, 2014 in federal court, BCBS IBC is permanently restrained and enjoined from issuing or pursuing any demand for repayment, or offsetting any new claims unless IBC complies with ERISA. ERISAclaim.com demystifies this new federal overpayment law in provider’s class action victory.

This permanent injunction from the federal class action court establishes the first and complete set of case laws for the overpayment recoupment and offsetting denials, the No. 1 health claim denials in USA”, says Dr. Jin Zhou

On May 19, 2014 in federal court, BCBS Independence Blue Cross (IBC) is permanently restrained and enjoined from issuing or pursuing any demand for repayment, or offsetting any new claims unless IBC fully complies with ERISA EOB and full and fair review regulations. IBC shall, within 150 days of the date of this Order, reform its policies regarding repayment demands directed to members of Plaintiff Pennsylvania Chiropractic Association (PCA). ERISAclaim.com demystifies this court permanent injunction, as the new federal overpayment laws, in provider’s class action victory.

Case Info: Pennsylvania Chiropractic Association, et al. vs Blue Cross Blue Shield Association, et al., Case: 1:09-cv-05619 Document #: 919 Filed: 05/19/14, 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), “After a bench trial on December 2, 3, and 4, 2013, the Court found in favor of the Pennsylvania Chiropractic Association (PCA) on its ERISA claims against Independence Blue Cross (IBC). See Pa. Chiropractic Ass'n v. Blue Cross Blue Shield Ass'n, No. 09 C 5619, 2014 WL 1276585 (N.D. Ill. Mar. 28, 2014). The Court also concluded that PCA is entitled to an appropriate permanent injunction and directed the parties to brief "the question of the precise contours the injunction should take." Id. at *18. PCA has now submitted a proposed permanent injunction, which requires IBC to provide ERISA-compliant notice and appeal when demanding that a health care provider repay previously issued health insurance benefits. For the reasons stated below, the Court approves PCA's proposed injunction in part.” according to court document.

“This permanent injunction from the federal class action court establishes the first and complete set of case laws for the overpayment recoupment and offsetting denials, the No. 1 health claim denials in USA”, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA and PPACA compliance, for overpayment appeals.

“This permanent injunction is a huge victory not only for PCA members but also for every patient and provider in USA. The court finally provides all health plans with full ERISA guidelines as intended by Congress”, explains Dr. Zhou.

According to court documents, in addition to the permanent injunction for IBC to fully comply with ERISA EOB and full and fair review regulations: “IT IS HEREBY ORDERED THAT defendant Independence Blue Cross (IBC) shall, within 150 days of the date of this Order, reform its policies regarding repayment demands directed to members of PCA as follows…” The court permanently restrained and enjoined IBC from any overpayment recoupment and offsetting unless IBC fully complies with ERISA regulations.

“AND IT IS FURTHER ORDERED THAT Defendant IBC is permanently restrained and enjoined from issuing or pursuing any demand for repayment of benefits previously paid to a PCA member, including offsetting any new claims based on an alleged overpayment, unless IBC complies with the procedures outlined above,” according to court document.

“AND IT IS FURTHER ORDERED THAT after the procedures are applied with regard to disputes raised by a PCA member concerning a repayment demand, any determination reached by IBC that upholds any portion of the repayment demand to the PCA member will constitute a new adverse benefit determination under ERISA for purposes of statutory or contractual limitations periods.” according to court document.

“More importantly, ObamaCare, PPACA, adopted ERISA claim regulation in its entire for all health plans”, says Dr. Zhou.

“(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

ERISAclaim.com offers new basic and comprehensive ERISA and PPACA overpayment appeals and litigation support programs, for all hospitals, providers and healthcare attorneys.

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.

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