New 2007 ERISA Appeal
Major Updates
ERISAclaim.com
04/06/2007
New Denial
Crisis Demanding for New Solutions
for Your
Reimbursement Problems
In 2007, healthcare
providers are facing unprecedented reimbursement crisis for healthcare
claim denials, delays and "overpayment" recoupment as well as managed
care PPO audits.
Several years ago, most
health care providers were seeing class actions against insurance
companies and managed care entities by 950,000 physicians across USA
after terribly failed political actions of "Patient's Bill of Rights"
campaign for eight years, and desperately hoping to see some positive
changes. In last several year those class actions were either settled
or dismissed by federal court.
Do you see any major
positive changes for your reimbursement?
No!
Now in 2007, the game is
totally different. More and more healthcare providers are the target
of healthcare fraud lawsuits and investigations, PPO fraud and abuse
audits, and more detrimentally harmful to financial bottom line for
many healthcare providers and facilities. We have been experiencing
more and more Volcano type of PPO audits and tornado type of
overpayment recoupment crisis from payers withholding subsequent claim
payments for millions of dollars, while no federal or state agency
seemed to have jurisdictions for healthcare provider’s Katrina crying
for justice, and while state government declined to intervene because
of ERISA preemption and federal government refused to investigate
because of alleged provider network contract agreement dispute, but
healthcare providers on behalf of your patients received no payments
or little payments for already approved claims as a result of
"overpayment" recoupment by the payers.
Most Comprehensive Research and
Analysis from US Supreme Court Rulings
US supreme court
unanimously ruled on June 21, 2004 that ERISA, a federal law, controls
and governs your problems in managed care crisis if you want any money
from the employer sponsored health plans.
Most Comprehensive, Advanced And
Practical Appeal Letters For “Overpayment Recoupment” Due To PPO
Audits And Medical Necessity As Well As Poor Documentation For Both
Self-Funded ERISA Plan And Fully-Insured ERISA Plan
Our new 2007 major
updates provide you with most powerful protections and advanced appeal
letters based on all of US Supreme Court recent rulings on managed
care reimbursement, ERISA state law and PPO preemption, state law
medical review preemption, and every type of practical arguments used
by payers in withholding and recouping benefits payment from
healthcare providers for those already approved benefits claims.
Latest Federal Court Ruling on
Disallowing Health Plan Recovery or Recoupment against Healthcare
Providers
Two new federal court
rulings on overpayment and state law prompted pay preemption relied
upon most recent US Supreme Court rulings, in addition to our 2006
updates in this area.
Latest Federal Court Ruling on
Definitive ERISA Preemption of State Prompt Pay Law.
For years, federal and
state regulators, legal and health care experts, health care providers
and insurance companies are not certain if federal law ERISA preempts
state Prompt Pay Laws, now federal court has ruled clearly that ERISA
definitely preempts state prompt pay laws based on analysis of Supreme
Court recent rulings.
97.96% Claims of United
Healthcare Lawsuit in These Case Were ERISA Claims
You will be also
surprised to learn that in this provider lawsuit against United
healthcare for wrongful denial of benefits claims.
"Plaintiffs
lawsuit centers around 295 claims for services rendered by Schoedinger
to patients covered by United healthcare plans. 289 of these claims
qualify as Employee Welfare Benefit Plans under ERISA, and 6 involve
non-ERISA plans.5 268 of the ERISA claims surround self-funded or
self-insured health plans, in which the employers are financially
liable for any benefits due and United serves only as the plan
administrator and claims processor. 21 of the ERISA claims and all of
the non-ERISA claims involve health plans that are fully insured by
United. For these 27 claims, United is financially responsible for the
benefits due to plan participants and serves as the plan administrator
and claims processor."
No PPO Participation, No Checks
to Non-PPO Providers, but ERISA Laws Protect You
Because certain major
payers are no longer sending reimbursement checks to healthcare
providers who were not participating in the network, we have
thoroughly researched federal law, ERISA, and developed a most
powerful but straightforward action plan package based on specific
federal ERISA regulation and requirements for healthcare providers to
receive reimbursement checks directly from the insurance payers.
New Federal Government Guidelines
on Filing Benefits Claims and Appeals
Our 2007 major updates
also include latest federal government, DOL, guidance on filing
healthcare claims and appeals
New Federal Government Guidelines
on Pre-Existing Condition Denials and Protections
Our 2007 major updates
also include latest federal government, DOL, guidance on filing
healthcare claims, appeals for pre-existing condition protections.
Our U.S. employment
market in modern society, divorce, relocation and adoption as well as
newborn babies have caused countless mysterious claim denials and
delays due to mysterious “additional information requesting” by payers
from patients and health care providers, but healthcare providers can
never find out what exactly addition information the payers are
looking for. These confidential information is not about privacy
compliance but pre-existing condition investigation, also governed by
HIPAA, money part of HIPAA regulation.
HIPAA pre-existing
condition regulation was never fully understood by healthcare
providers, as HIPAA is part of ERISA regulation.
If you want to get paid
quickly and accurately for 90% of your non-Medicare claims from
patients obtained health insurance from employment in private sectors,
you must understand and follow published federal government
guidelines.
How to Order?
Our new 2007 ERISA
Appeal Updates can be ordered for $95 by those who have previously
purchased our ERISA Appeal CD Book and Systems, and these
updates cannot be separately purchased without prior purchase of
ERISA Appeal CD Book and Systems for $450. However Our new 2007
ERISA Appeal Updates is free to those who have purchased ERISA
Appeal CD Book and Systems in past 30 days from
04/07/2007.
You may place your order
from our website, www.ERISAclaim.com on page of Appeal
Books and Systems at
http://www.erisaclaim.com/products.htm
You may also call us at
630-736-2974 for a phone order or any questions
