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Affordable Care Act Regulations and Guidance
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ERISAclaim.com Press Release

 

New Health Reform Law Claim Denial Appeal Book Announced for Healthcare Providers to Comply with New PPACA Deadline – 09/23/2010  06/28/2010, Hanover Park, IL

 

New Health Reform Law Appeal Certification Class Announced for Hospitals to Comply with New PPACA Deadline – 09/23/2010  06/24/2010, Hanover Park, IL

 

ERISAclaim.com Webinars On Healthcare Revenue Cycle Crisis Turnaround: Pre-Payment Review Delays and Denials – Deemed Denial ERISA Appeals  04/19/2010, Hanover Park, IL

 

Health Reform for Out-Of-Network Providers: Receiving Insurance Checks Directly? – Free Webinars on Why and How  04/05/2010, Hanover Park, IL

 

Health Reform For Doctors And Hospitals: Obama Made An Offer We Can’t Refuse! - ERISAclaim.com Celebrates its Successful Webinars on New Healthcare Reimbursement Laws  04/05/2010, Hanover Park, IL

 

New Free Webinars Announced to Discuss the Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws for the Skyrocketing $6 Trillion Overpayment Recoupment Market 03-29-2010, Hanover Park, IL

 

New Free Obama Health Law Webinars Announced For Healthcare Providers and Health Plans on New Reimbursement Laws for Claims Processing and Appeals 03-23-2010, Hanover Park, IL

 

The New TPA ERISA Appeals Department Training Program Announced for Self-Insured Health Plan’s Denial and Appeal Management To Compliantly Contain Administrative Costs 02-11-2010, Hanover Park, IL

 

The New ERISA Overpayment Appeals And Anti-Fraud Services Announced For Healthcare Providers Through ERISA Appeals And Anti-Fraud Compliance 02-08-2010, Hanover Park, IL

 

The New Hospital ERISA Appeals Department Program Announced for Hospital In-House Denial Management and Financial Crisis Turnaround  02-08-2010, Hanover Park, IL

 

The New 2010 Obama Healthcare Reimbursement Law Webinars Announced As ERISA Appeals Procedures Now Mandatory for All Group Health Plans and Healthcare Providers  01-04-2010, Hanover Park, IL

 

Free Overpayment Webinar Announced For Self-insured Health Plans To Get Immediate Relief from New $1 Trillion Overpayment Recoupment Embezzlement Market 11-23-2009, Hanover Park, IL

 

New Healthcare Overpayment Recoupment Embezzlement Recovery Service Announced In Wake Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis 11-19-2009, Hanover Park, IL

 

The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL

 

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

 

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New Health Reform Law Claim Denial Appeal Book Announced for Healthcare Providers to Comply with New PPACA Deadline – 09/23/2010  06/28/2010, Hanover Park, IL

The First New Health Reform Law, PPACA, Claim Denial Appeal CD Book Was Announced by ERISAclaim.com for Healthcare Providers to Appeal Claim Denials and Delays, to Comply with New Health Reform Law, Going into Effect on Sept. 23, 2010, for All Group Health Plans And Healthcare Providers.

New Health Reform Law Appeal Certification Class Announced for Hospitals to Comply with New PPACA Deadline – 09/23/2010  06/24/2010, Hanover Park, IL

The First PPACA Appeal Certification Class for Hospitals Was Announced by ERISAclaim.com. New Federal Reform Law, Patient Protection and Affordable Care Act, PPACA, Signed into Law by President Obama on March 23, 2010, Mandates Full Compliance with PPACA New Claim Appeal Process For All Group Health Plans And Healthcare Providers Effective Sept. 23, 2010

ERISAclaim.com Webinars On Healthcare Revenue Cycle Crisis Turnaround: Pre-Payment Review Delays and Denials – Deemed Denial ERISA Appeals  04/19/2010, Hanover Park, IL

New Webinars Announced From ERISAcaim.com To Resuscitate Revenue Cycle Crisis With Right Federal Law Magic. Providers Are Seemingly Left With No Common Remedies In Wake Of Financial Debilitating Overpayment Demand And Recoupment From Payers, An Increasing Number Of Healthcare Providers Are Also Facing Bankrupting Pre-Payment Review Delays For Up To Over A Year Of No-Pays And Real Denials, In An Unprecedented U.S. Healthcare Avatar: No Payment From Insurance Companies But Pay Back To Insurance Companies By Providers. Once Informed Of Pre-Payment Reviews, All State Prompt Pay Laws No Longer Apply.

Health Reform for Out-Of-Network Providers: Receiving Insurance Checks Directly? – Free Webinars on Why and How  04/05/2010, Hanover Park, IL

ERISAclaim.com Expanded Its Free Webinars to Cover New Obama Health Reform and Reimbursement Laws for Out-Of-Network Non-Participating Provider's Rights to Receive Insurance Reimbursement Checks Directly with Valid Assignment and Nondiscrimination Protections for Nonparticipation. New Obama Health Reform Law Mandates Every Group and Individual Health Plan to Accept Patient Assignment to Send Reimbursement Checks Directly to Providers Regardless of Participation, by Incorporating Existing Federal Law, ERISA, and in Consistent with Recent U.S. Supreme Court Orders.

Health Reform For Doctors And Hospitals: Obama Made An Offer We Can’t Refuse! - ERISAclaim.com Celebrates its Successful Webinars on New Healthcare Reimbursement Laws  04/05/2010, Hanover Park, IL

ERISAclaim.com Is Celebrating Its Successful Webinars On New Healthcare Reimbursement Laws, Offered Since The House Passed Its Version Of Sweeping Reform Bill In Last November, And Subsequent Senate Bill With Identical Provisions For Appeals Laws. After President Obama Signed Into Law The Final Bill On March 23, 2010, Healthcare Providers Have Attended Its Daily Webinars With Overwhelming Reactions: Obama Made An Offer We Can’t Refuse, “To Receive Continued Coverage Pending The Outcome Of The Appeals Process”.

New Free Webinars Announced to Discuss the Latest Federal Court Overpayment Lawsuit Ruling and New Obama Health Laws for the Skyrocketing $6 Trillion Overpayment Recoupment Market 03-29-2010, Hanover Park, IL

New Free Webinars Announced From ERISAclaim.com To Discuss The Latest And The First Federal Court Ruling On March 18, 2010 That A PPO Participating Provider’s Lawsuit Against Anthem BCBS, For The Alleged Wrongful Overpayment Recoupment and Even Withholding From Different Patients, Is Completely Governed By Federal Law, ERISA, Rather Than PPO Contracts And State Laws. The Court Decision Was Mainly Relied Upon U.S. Supreme Court Rulings, the Federal Court Ruling Is Timely Consistent With New Obama Health Reform Laws That Mandate ERISA Appeals For All Group Health Plans And Health Providers. The Federal Court Timely Ruling and New Health Reform Law Mandates Are Vital and Crucial Guidance for a Potentially $6 Trillion Overpayment Market for Every One In Healthcare Delivery System.

New Free Obama Health Law Webinars Announced For Healthcare Providers and Health Plans on New Reimbursement Laws for Claims Processing and Appeals 03-23-2010, Hanover Park, IL

The Final Health Reform Bill Has Been Signed By President Obama Into The Law Of The Land For More Than 95% Americans, As The Most Significant Changes Since Medicare Was Created 45 Years Ago. What Does Obama Healthcare Law Mean To Healthcare Providers And Health Plans? New Free Webinars From ERISAclaim.com Was Announced To Discuss New Federal Reimbursement Law Mandates For All Group Health Plans And Health Care Providers: ERISA Internal And External Appeals, Extended Disclosure And Appeal Rights, New Federal UCR Fee Centers And New Federal Simplified, Uniform Standards For Claim Processing And Appeals.

The New TPA ERISA Appeals Department Training Program Announced for Self-Insured Health Plan’s Denial and Appeal Management To Compliantly Contain Administrative Costs 02-11-2010, Hanover Park, IL

For The First Time In U.S. Health Care History, ERISAclaim.com Announced The Nation’s First TPA ERISA Appeal Management Department Program To Provide TPA’s and Self-Insured Health Plans With A Turn-Key Set-Up Training For The In-House ERISA Appeals Management Department To Process ERISA Appeals Compliantly to Contain Administrative Costs and Avoid Unnecessary Litigations, In Wake Of The New Pending Obama Health Reform Laws Mandating ERISA Compliance for All Group Health Plans Within Six Months of The Enactment

The New ERISA Overpayment Appeals And Anti-Fraud Services Announced For Healthcare Providers Through ERISA Appeals And Anti-Fraud Compliance 02-08-2010, Hanover Park, IL

In Light of Increasing Frivolous And Debilitating Overpayment Refund Demand From Payers, ERISAclaim.com Announced The Nation’s First ERISA Overpayment Appeals and Anti-Fraud Services to Help Healthcare Providers to Effectively Appeal All Alleged Overpayment Denials in Essence of Retrospective Benefits Denials and Increase Fraud and Abuse Prevention ‘Compliance, As Federal Law ERISA Governs All Denials of Benefits From ERISA Plans and Prohibits Fraudulent Interference with ERISA Rights

The New Hospital ERISA Appeals Department Program Announced for Hospital In-House Denial Management and Financial Crisis Turnaround  02-08-2010, Hanover Park, IL

For The First Time In U.S. Health Care History, ERISAclaim.com Announced The Nation’s First Hospital ERISA Appeal Department Program To Provide Hospital With A Turn-Key Set-Up Training For The In-House ERISA Appeals Department To Combat Commercial Managed Care Denials, Overpayment Recoupment Crisis, And Revenue Cycle Outsourcing Dilemmas For Hospital Survival, And ERISA Compliance, In Wake Of The Latest AHA Report Of More Than $36 Billion Hospital Uncompensated Care Cost

The New 2010 Obama Healthcare Reimbursement Law Webinars Announced As ERISA Appeals Procedures Now Mandatory for All Group Health Plans and Healthcare Providers  01-04-2010, Hanover Park, IL

The Final Health Bill Passed In Senate On Christmas Eve Is Completely Consistent With House Health Bill By Incorporating ERISA Claim Regulation In Its Entirety For All Group Health Plans Into Obama Health Reform, For 200 Million Americans Under New Obama Universal Healthcare Laws. ERISA Appeal Process Is Now Mandatory For All Group Health Plans And Healthcare Providers As Well As Consumers. First Free Monthly ERISA Webinar starts on 01/18/2010, and First Advanced ERISA Claim Specialist Certification Program Starts in Feb. 2010.

Free Overpayment Webinar Announced For Self-insured Health Plans To Get Immediate Relief from New $1 Trillion Overpayment Recoupment Embezzlement Market 11-23-2009, Hanover Park, IL

Overpayment Recoupment Embezzlement Fraud Is Typically Committed Sophisticatedly By Health Plan's Third-Party Administrators (TPA) Or "Madoff TPA" For Failing To Refund Or Return The Recouped Overpayment Money To The Original Self-Insured Health Plans. “Anti-Fraud Initiative Is Not Complete Until And Unless The Recouped Overpayment Money Originated From The Plan Assets Is Finally Returned To The Original Self-Insured Health Plans, Or The Fake Anti-Fraud Crusaders Are The Real Fraud Culprit”, Said Dr. Jin Zhou.

New Healthcare Overpayment Recoupment Embezzlement Recovery Service Announced In Wake Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis 11-19-2009, Hanover Park, IL

Will Obama's New Financial Fraud Task Force Catch The New "Trillion-Dollar Madoff" In The Widespread $1 Trillion Healthcare Overpayment Recoupment Embezzlement Crime? ERISAclaim.com Believes That Private Sectors Shall Be The Equal Partners To The Federal Government In Fighting And Preventing Another Financial Meltdown, And Must Take Proactive And Primary Roles In Conjunction With The Government Fraud Task Force To Save Our Economy And Healthcare System.

The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL

"New Health Care Reform Bill, The Affordable Health Care for American Act, Was Passed by the House Of Representatives Saturday Night, and Is Expected to Be Signed into Law by the President Obama by the End of the Year with Absolute Confidence. ERISAclaim.com Announced the First Claim Specialist Certification Class Specifically for the Compliance with the New Federal Healthcare Law for 96% of Americans"

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 is offering a unique ERISA recovery service for midsized and large sized employer-sponsored ERISA health plans from potential or probable embezzlement, kickback, concealment and negligence as well as mismanagement from TPAs and ASOs to recoup potentially hundreds of millions of dollars from current healthcare industry overpayment practice and mismanagement. ERISAclaim.com has gained its unique industry in-depth knowledge and expertise from working with every segment of health care industry in more than 10 years. With unique knowledge of the industry known facts, ERISAclaim.com is dedicated to helping large ERISA plans to recover millions of dollars on a complete contingency basis."

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 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.

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

"Effective on October 19, 2009, ERISAclaim.com is expanding its Litigation Support Division for healthcare claims in response to the skyrocketing overpayment recoupment dispute and claim denial litigations in the $6 trillion healthcare denial management market. Federal law ERISA governs more than 80-90% of the insurance and benefit payment for non-Medicare claims for 35 years, when inevitable, litigation is the only legal avenue to resolve healthcare claim dispute to avoid more middle-class bankruptcies for 170 million working Americans and their families covered under ERISA plans." Click for more......

 

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

"For the first time in U.S. healthcare history, ERISAclaim.com is offering the nation's first two-day ERISA Program for overpayment dispute and claim denials, starting from January 12-13, 2010, in Chicago Illinois, for healthcare providers, managed-care third-party payers (TPA), benefits administrators and healthcare attorneys as well as the state regulators. This two-day ERISA seminar is mainly designed to train skilled ERISA Appeal Staff to fight over new claim crisis, and to develop the Special Appeals Department for doctors and hospitals, in conjunction with our optional ERISA Certification Programs for ERISA Claim Appeal Specialist." Click for more......

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

 

Committed to Compliant Education for Medical Claim Dispute Resolution

"For the first time in U.S. healthcare history, ERISAclaim.com is offering the nation's first eight-day Certification Program for ERISA Claim Appeal Specialist, starting from January 14-15, 2010, in Chicago Illinois, for healthcare providers, managed-care third-party payers (TPA), benefits administrators and healthcare attorneys as well as the state regulators. This ERISA Certification Program is a comprehensive, systematic and advanced problem-oriented interactive learning process, designed to learn and master the most important federal law, ERISA, which governs and regulates more than 90% of non-Medicare commercial claims and more than 60% of healthcare claim denial reasons for the past 35 years." Click for more......

 

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Event Listings

 

 

 

 

 

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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