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Legal Disclaimer
The publication or information
on this Website is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is presented and
published with the understanding that the author and publisher are not
engaged in rendering legal, accounting or other professional service or
advice. If legal advice or other expert assistance is required, the services
of a competent professional person should be sought.
We're not employees
of, or in affiliation with any governmental or regulatory agencies.
ERISAclaim.com
is not a law firm. We do not practice law. If legal action or advice is
required to successfully resolve a claim or a claim/business decision, we
will refer out our client to an outside legal counsel chosen by our client.
We do not
teach, advise or participate in coding & billing of your health care claims and
practice. We advocate appeals of your already denied claims
through compliance and compliant claim processing for savings in accordance
with ERISA claim regulations and applicable federal and state laws.
Although
ERISAclaim.com often works in conjunction with, but completely
independent from, different law firms or seminar sponsors whose practice is
focused on the representation of or advising clients in health care ERISA
claims dispute or compliance, those law firms or companies
advertising on ERISAclaim.com are not
affiliated with or employed by or with ERISAclaim.com. ERISAclaim.com
disclaims any and all responsibility or liability for the accuracy, content,
completeness, legality, reliability, or operability or availability of
information or material displayed or
advertised
on the
ERISAclaim.com.
ERISAclaim.com disclaims any
responsibility for any harm resulting from downloading or accessing any
information or material on the Internet linked to or through the
ERISAclaim.com.
Except for otherwise specifically stated, our educational and training for
certification programs are
not affiliated with any
governmental or educational institute for the purpose of "recognized
accreditation or certification for compliance programs or compliance
officers" or degrees. Our certifications are only for personal
attendance in private studying subject materials
specified in each individual programs for advancing educational knowledge
with respect to applicable business and compliance.
OIG: Special Advisory Bulletin: Practices of Business
Consultants
[PDF] [http://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf]
The Office of Inspector General (OIG), Department of Health and Human
Services, June, 2001
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Privacy and Security
Statement
Thank you for visiting the
ERISAclaim.com and reviewing our privacy and security statement.
ERISAclaim.com is strongly committed to maintaining the privacy
of your personal information and the security of our computer systems.
With respect to the collection, use and disclosure of personal
information, ERISAclaim.com makes every effort to ensure
compliance with applicable Federal and State laws.
As a general rule, the ERISAclaim.com
does not collect personally-identifying information about you when you
visit our site, unless you choose to provide such information to us.
The information we receive depends upon what you do when visiting our
site.
If you respond to an on-line
request for personal information:
Generally, the information requested by
the ERISAclaim.com will be used to respond to your inquiry or
to provide you with the service associated with the request. However,
when this information is requested, the reasons for collecting it with
a description of the ERISAclaim.com intended use of the
information will be fully described in a customized "Privacy Notice."
This Privacy Notice will either appear on the Web page collecting the
information or be accessible through a link prominently displayed
immediately preceding the information request.
If you visit our site to read or
download information, we collect and store the following information:
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The name of the domain from which you
access the Internet (for example, dol.gov, if you are connecting
from the Department of Labor's computer account).
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The date and time you access our
site. |
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The Internet address of the Web site
from which you linked directly to our site. |
The above information is used by
software programs on our Web site to create summary statistics which
allow us to assess the number of visitors to the different sections of
our site, identify what information is of most and least interest,
determine technical design specifications, monitor system performance,
and help us make our site more useful to visitors.
If you identify yourself by
sending an e-mail containing personal information:
You also may decide to send us
personally-identifying information, for example your mailing address,
in an electronic mail message requesting that information be mailed to
you. Information collected in this manner is used solely for
responding to requests for information or records. We do not forward
or sell your e-mail to any third party.
If you link to other sites
outside ERISAclaim.com:
Our Web site has many links to other
sites. When you link to any of these sites, you are no longer on our
site and are subject to the privacy policy of the new site.
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For
security purposes and to ensure that this service remains available to
all users, our Web site also employs software programs to monitor
network traffic to identify unauthorized attempts to upload or change
information, or otherwise cause damage.
You are hereby notified that use of this site constitutes consent to
such monitoring and the above captioned "Legal Disclaimers" as
well as our "Privacy and Security
Statement".
If you visit our site, we collect and store the following information
only: the name of the domain from which you accessed the Internet
(e.g., aol.com); the IP address from which you accessed this site; the
date and time you accessed the site; and the pages you visited.
Unauthorized attempts to upload
information or change information on this service are strictly
prohibited and may be punishable under the
Computer Fraud and Abuse Act of 1986 and
The National Information Infrastructure Protection Act of 1996.
Unauthorized modification of any information
stored on this system may result in criminal prosecution.
The author and publisher of ERISAclaim.com
is not responsible for the creation or maintenance of web sites linked
to this site, and does not vouch for the accuracy, completeness, or
currency of any of the materials included on them.
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Frequently Asked Questions
1.
Who Will Benefit from This Web
Site and Services?
2.
Why is ERISAclaim.com So
Different?
3.
How to Effectively Use
This Website?
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1.
Who Will Benefit from
This Web Site and Services?
This Website, consulting
and seminar as well as new ERISA CD book are primarily written for
physicians, clinics and hospitals or any health-care providers who deal with
health-care claims under ERISA, for patients who obtained health insurance
through employment in private sectors, up to 80% of U.S. health-care
market. For 27 years, ERISA has been poorly understood by health-care
provider community and their patients. Our nation has spent 1.3 trillion
dollars in health-care expenses last year, about 14% of entire national
domestic product, two of the four main causes (extremely high administrative
costs and managed care problems) are directly associated with healh-care
coverage dispute and claims denials under ERISA.
Managed care market and
health-care industry are facing most difficulties and frustrations, many of
health-care professionals and medical facilities have changed their business
dramatically due to such managed care challenge. This entire problem is
directly related to ERISA statutory structure and administrative
enforcement, yet health-care professionals never understand ERISA, let alone
any compliance to ensure their ERISA rights. Health-care related litigation
explosion is the news media everyday.
This Website, consulting
and seminar as well as new ERISA CD book are mainly focused on ERISA claim
denials and appeals, especially at such critical time when new federal final
claim regulations are to be effective in January 2002 while health-care
providers were hardly informed of this greatest protections for their
business survivals.
This Website, consulting
and seminar as well as new ERISA CD book are primarily published and written
for physicians, clinics and hospitals as well as any health-care providers,
not preliminary for academic and legal community. This Website does not
focus on basic codings and billings, Medicare, workers compensation,
automobile related injuries as well as non-ERISA claims, traditional
insurance claims.
2.
Why is ERISAclaim.com So
Different?
While almost 80 percent of
health-care claims are ERISA claims, regulated by ERISA for 27 years and our
managed care problems escalated each year to almost a breaking point for
physicians nationwide, ERISA remains a judicial mystery and courtroom
drama. Nobody has been able to demystify ERISA and make ERISA and everyday
health-care claim denials and appeals in one practical package for busy
physicians in their day-to-day business practices. The author of
this book has spent about seven years in
researching, studying and implementing ERISA principles and applications,
including ERISA statutes, regulations, applicable court rulings and
real-life claim processing, in everyday ERISA claim appeals practice, and
has finally demystified extremely complicated and frustrated ERISA laws,
developed a nation first ERISA compliance and appeals system, most
comprehensive and practical handbook with numerous computerized sample
appeals letters, covering almost every type of commonly seen ERISA denials
and appeals, consistent with ERISA statutes and regulations as well as U.S.
Supreme Court rulings. The purpose of this book is to demystify the
existing federal laws, promote ERISA compliance by physicians, to file ERISA
required and qualified appeals in order to enjoy maximal protections for
physician's health-care claims.
3.
How to Effectively Use
This Website and New CD Book?
It is important to
understand that this Website and related seminars and consulting services
are about compliance, then protections and benefits. Any principles and
strategies referenced on this web site or used in the new CD book are based
on existing and sounding legal principles, supported by statutes,
regulations and case laws. It is advised that no expectation of overnight
success or miracle shall be promised but great effort of new thinking,
persistent studying and unprecedented action taking shall be made by
physicians and their businesses.
The new CD book is written in digital format on a CD, navigation system
and tools are more sophisticated than paper format, however reading lengthy
information on a computer screen is not popular or practical for most
people. It is suggested that printing selective pages combined with digital
navigation and researching tools will maximize benefits of
this new book.
Text files of sample
appeal letters for WordPerfect, Microsoft Word and general text word
processor are enclosed in this book on the same CD. Some minimal
modification or revision of basic information of these sample appeal letters
will make this book one of the most time-saving and effective appeals
practice for everyday busy physician's ERISA claim denials.
Due to its unprecedented
nature of knowledge and system, many questions are expected from readers
nationwide. It is not a guarantee of this author to provide individual
answers for any possible questions about this book, questions posted through
e-mail or posted on this discussion forum of this web site may be answered
as an option from this author.
It is also necessary for
future seminars with face-to-face discussion of ERISA claim denial and
appeals. Any health-care professional organizations and medical societies
with interest of further promotion of ERISA compliance and understanding of
new Federal Final Claim Regulations may contact this author
through e-mail or
telephone for specific seminars.
ERISA litigation and court
ruling are evolving constantly.
New federal final claim regulations are scheduled to be effective in January
2002. Physicians and health-care providers are better protected in
their medical claim practice by following up with these judicial and
regulatory development. A Registration Form is enclosed with this book for
readers in order to provide updated analysis of new court rulings,
especially U.S. Supreme Court, and new development of final claim
regulations. It is recommended for readers of this book to complete
registration form and be informed of any new development in ERISA court
rulings and regulatory updates, traditionally only available to legal
community and insurance and benefits industry.
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ERISA &
Claim Denials
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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" |
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ERISA &
Health Claim |
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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." |
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$10,600 ERISA Claim
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| 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.
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