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New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

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Affordable Care Act Regulations and Guidance
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bullet Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections: Regulation • Fact Sheet • Patient Protection Model Notice • Lifetime Limits Model Notice • Dependents Model Notice
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Employee Retirement Income Security Act — ERISA

bullet ERISA Claims Procedure, 29 CFR 2560.503-1: Regulation • FAQ • Fact Sheet • Claims Guide • Claims Card
bullet Amendments to Summary Plan Description Regulations, 29 CFR 2520.102-3: Regulation • Fact Sheet • News Release • SPD Rights Fact Sheet • SPD from DOL
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Webinars, Seminars & Certification Classes for New Federal Health Claim Appeals Regulations

 

ERISAclaim.com - Free Webinars - New Federal Claims & Appeals Regulations, Effective Sept. 23, 2010, for 193 Million Americans

 

ERISAclaim.com: Seminars - 2010 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals

 

ERISAclaim.com - 2010 PPACA & ERISA Claim Specialist Certification Programs in Chicago, Illinois

 

ERISAclaim.com:  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)

 

ERISAclaim.com Press Release

 

FOR IMMEDIATE RELEASE:

 

ERISAclaim.com Announced Free ERISA Webinar for Healthcare Overpayment Dispute and Claim Denials in Response to Increasing High Demand from the $6 Trillion Healthcare Denial Management Market  

ERISAclaim.com is offering free ERISA seminars monthly for healthcare claims in response to the skyrocketing overpayment recoupment dispute and claim denial litigations. Although every day for 35 years, doctors and hospitals were told by insurance Co.'s and payers, on every EOB, to file ERISA Appeals for all denied and delayed claims, very a few providers knew how to, as there has been very little resource available for provider ERISA appeals. Now facing Claim's "WWII" as the overpayment recoupment crisis for those previously paid claims on the top of the increasing new claim denials, the providers are desperately demanding for the ERISA appeal guidance. ERISAclaim.com's free ERISA Webinar is open to all healthcare and benefit professionals.

Hanover Park, IL (PRWEB) October 19, 2009 -- Effective on October 20, 2009, ERISAclaim.com is offering free ERISA seminar monthly for healthcare claims in response to the skyrocketing overpayment recoupment dispute and claim denial litigations in the $6 trillion healthcare denial management market. Although every day for 35 years, doctors and hospitals were told by insurance Co.'s and payers, on every EOB, to file ERISA Appeals for all denied and delayed claims, very a few providers knew how to, as there has been very little resource available for provider ERISA appeals. Now facing Claim's "WWII" as the overpayment recoupment crisis for those previously paid claims on the top of the increasing new claim denials, the providers are desperately demanding for the ERISA appeal guidance and expertise for provider ERISA appeals. ERISAclaim.com is making the healthcare industry history with nation's first exclusive free ERISA seminars for all claim denial and delays with employer sponsored health plans covering an estimated 170 million Americans.

 

ERISA, Employee Retirement Income Security Act of 1974, is a federal law that governs and regulates healthcare claims for estimated more than 170 million Americans who obtained health insurance or benefits from employment in private sector, for both self-insured and fully-insured (through purchase of insurance) health plans. ERISA law completely (100%) preempts, supersedes and invalidates any and all state laws and private managed-care contracts for PPOs and HMOs in any and all dispute over denial of benefits from an ERISA plan. ERISA regulates and governs healthcare claims which include the paid ERISA healthcare claims in more than 50% of $2.4 trillion, 16.6% of GDP, of the national health expenditure in 2008, and also include the denied healthcare claims, legitimately or wrongly for appealable claims, in more than 50% of $5 trillion in the aggregated denied healthcare claims in 2008. More than 60-70% of healthcare claim denials from insurance companies and managed-care third-party payers by employer-sponsored plans are due to ERISA regulated plan or policy coverage, limitations and exclusions rather than traditional billing, coding, medical necessity and managed care contracting or participation dispute. Although in the past 35 years the notices for ERISA rights to appeal were written on almost every EOB (Explanation of Benefits) in the daily practice in doctors' offices and hospitals, the healthcare providers, managed-care third-party payers, and even legal professionals as well as the state regulators rarely understood how to conduct, manage or regulate ERISA claim appeals for ERISA claim denials and disputes.

 

There have been urgent and popular market demands for ERISA healthcare claim appeal as the ERISA law, rather than billing, coding and managed care contract, completely governs denial of benefits per U.S. Supreme Court in Aetna v. Davila, for 170 million civilian working Americans and their families. Failure to appeal by doctors and hospitals for denied claims is the one of the main reasons for more and more middle-class bankruptcies when 77.9 percent of those bankrupted by medical problems had health insurance at the start of the bankrupting illness, including 60 percent who had private coverage from ERISA plans in this $6 trillion healthcare denial management market.

 

More and more class action lawsuits have been filed recently under ERISA and RICO on behalf of doctors and hospitals for overpayment disputes in order to avoid provider's financial disasters and bankruptcies, however, ERISA law requires the plaintiff to completely exhaust ERISA appeal remedies before filing any lawsuit in Federal Court. Multi-billion dollars have been reportedly recouped by Payers and managed care TPA's in private sector, in addition to now popular Medicare RAC overpayment program.

 

ERISAclaim.com is currently the only company in the country that provides comprehensive, systematic and advanced ERISA healthcare claim education, consulting and publishing primarily for the healthcare providers and industry consultants.

 

ERISAclaim.com, located in northwestern suburb of Chicago, Illinois, is an online publisher, consultant and educator for ERISA claim education, training and consulting as well as claims recovery for ERISA healthcare claims. It also provides ERISA litigation support, research assistance and fraud and abuse prevention as well as PPO auditing defense consulting. In addition to ERISA, ERISAclaim.com also provides consulting and education for Medicare Claim Appeals Specialist, for Medicare RAC overpayment appeals, fraud and abuse prevention.

 

Dr. Jin Zhou, the president of ERISAclaim.com, developed the nation's first ERISA education and practical appeal system for healthcare providers 10 years ago. He has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers and assisting trial lawyers frequently for more than 10 years. Dr. Jin Zhou was sometimes referred to as the "Godfather of ERISA Claims" for healthcare providers by some industry experts. His ERISA expertise and experience are unique and different from that in traditional ERISA appeal and litigation for disability claims on behalf of patients instead of healthcare providers with billing and coding, medical necessity and managed-care contracting and network complications.

 

For more information or to arrange an interview, please visit http://www.erisaclaim.com/PR0004.htm,   or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

 

###

Contract:

Jin Zhou, President

ERISAclaim.com

Tel: 630-808-7237 (Mobile)

Tel: 630-736-2974 (Office)

Fax: 630-736-1439

E-mail: ERISAclaim@aol.com

website: http://www.ERISAclaim.com

 

Related Press Release links:

 

ERISAclaim.com Announced The Nation's First Embezzlement Recovery Services for Large ERISA Health Plans from the $6 Trillion Healthcare Denial Management Market 10-23-2009, Hanover Park, IL

 

ERISAclaim.com Announced Free ERISA Webinar for Healthcare Overpayment Dispute and Claim Denials in Response to Increasing High Demand from the $6 Trillion Healthcare Denial Management Market  10-19-2009, Hanover Park, IL

 

ERISAclaim.com Announced the Expansion of Its ERISA Litigation Support For the Healthcare Claims In Response to Increasing High Demand from the $6 Trillion Healthcare Denial Management Market. 10-19-2009, Hanover Park, IL

 

ERISAclaim.com Announced 2010 ERISA Seminars for Healthcare Overpayment and Claim Denial Appeals for the $6 Trillion Healthcare Denial Management Market. 10-14-2009, Hanover Park, IL

 

ERISAclaim.com Announced the Nation's First Certification Program for the ERISA Claim Appeal Specialist for Healthcare Providers and Managed-Care Payers, 10-13-2009, Hanover Park, IL

 

 

 

 

 

 

ERISA & Claim Denials

Aetna Video Shows ERISA Patients Mistreated

 

"According to the video, when faced with claims for identical medical problems, Aetna separates the claims where no damages are available - those subject to the federal Employee Retirement Income Security Act, or ERISA - from non-ERISA claims, where consumers can sue.1 2"

 

ERISA & Health Claim
What Is ERISA and How Does It Affect Patient Rights?

 

"ERISA was enacted in 1974 to protect the pension and welfare benefits that employers provide their workers. It currently covers about 2.5 million health plans and 125 million workers, retirees, and dependents."

 

Department of Labor

 
"A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Most private sector health plans are covered by the

 Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law."

 

 

$10,600 ERISA Claim

Recent Federal Court Ruling in a Case with $10,600 medical claim, insurance Co. refused to pay, provider made numerous demand for payment in almost one year, but no appeals filed, the court dismissed the lawsuit because provider failed to exhaust administrative remedy, as required under ERISA, by filing ERISAclaim appeals.  This situation is so popular in health-care community.

 

 

 

 

Agree to terms and conditions

"Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply."

 

CIGNA - Coverage Positions/Criteria
"The terms of a participant's particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Positions are based. If these Coverage Positions are inconsistent with the terms of the member's specific benefit plan, then the terms of the member's specific benefit plan always control."

 

UnitedHealthcare Medical Policies

"By clicking "I agree," you agree to be bound by the terms and conditions expressed below, in addition to our Site Use Agreement.

UnitedHealthcare medical policies have been made available to you as a general reference resource. When reading these policies you agree that:

Our Medical Policy is not your patient's Benefit Plan.

Your patient's medical benefits are governed and determined by a benefit document, either a Certificate of Coverage or a Summary Plan Description. You should not rely on the information contained in this Web site section to determine your patient's medical benefits.
 

  1. Federal and state mandates and the patient’s benefit document take precedence over these policies.

  2. The patient’s benefit document lists the specific services that have coverage limits or exclusions.


Our Medical Policy does not address every situation and individuals should always consult their physician before making any decisions on medical care."

 

 

   
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