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Physicians CCI EDITS



Tel 903 839-7045,
FAX 903 839-7069


Moukawsher & Walsh, LLC
Pension and Employee Benefit Law


SPD's for FEHB

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FEHB Plan Brochures


Links to Plan Bronchures for 2009


Links to Plan Brochures for 2003


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Links to the FEHB Open Season for 2005 Brochures



Federal Employees Health Benefits Program






TRICARE Handbook



SPD's for NJ State


for employees and retirees

January 2003  (pdf)

Health Insurance Mandates in the States, 2004: a State-by-State Breakdown ... (PDF) (Council for Affordable Health Insurance)

U.S. Healthcare Crisis Turnaround?

U.S. A.

Drs. & Hospitals Employers

$1.0 Trillion / Year

$$$ ERISA $$$

50% Savings

The Only Company with Compliant Solutions for All of You

Rx-1  $$$$$$$$$ERISA$$$$$$$$$$  Rx-2

US Supreme Court Visits
at 11:57:03 AM on Friday, November 21, 2003 Order Sheet

We Accept Checks, Visa, Master, Discover & America Express Cards

Click to Enter Our Secured Order Page



CD Books

CD-001 ERISA Appeal CD Book with 2010 Update $450.00
CD-011 ERISA Appeal CD Book - 2010 Update Only $150.00
CD-002 2009 Guide to New Medicare Appeal Process with 2010 Update $395.00
CD003 2006 Medicare Medicare Necessity, Documentation and Appeals, with 2010 update $250.00
CD004 2005 New IL Workers Compensation Laws, Forms and Letters






SE-001 ERISA / PPACA Regulations Appeals - Public


SE-002 ERISA / PPACA Regulations Appeals - Private/On site


SE-003 Overpayment Appeals & Strategy - Private/On site


SE-004 Corp.  Compliance: Fraud & Abuse Prevention - Private/On site



Out-of-Network Practice & Reimbursement







Pre-Payment Review Delays & Denials - Private/On site



SIU Delays & Denials, ERISA Pre-emption -  Private/On site


CO-003 Your Problem Oriented & Solutions -  Private/On site





 Litigation Support

LI-001 ERISA Claims Regulations & Litigation Strategies



Claims Recovery


Call 630-808-7237

45% of Recovery


Plan Assets Recovery & Audits

(Overpayment Recoupment Recovery)

PA-001 For Self-Insured/Funded Health Plans Only

45% of Recovery





WE-001 Single Topic - Problem Oriented - Private


WE-002 One-Hour VIP Webinar for Group - Email or Call to Setup (630-808-7237)


WE-003 PPACA Webinars for Hospital CFOs Biweekly, Two-hours/Session,




  ** plus actual expenses & costs  



New PPACA / ERISA Appeal Book with 2010 Major Updates

with New Health Reform Law PPACA Compliance

$450  & $150 (Updates only with previous purchase)



New Denial Crisis Demanding for New Solutions

for Your Reimbursement Problems

See More Detalis Below to Order

Fax Order Form (Click Here)

Click here or the CD-Picture to enter our Secured Online Order page

With New 2010 Major Update


$450 ERISA CD Book


Fax Order Form (Click Here)

Click here or the CD-Picture to enter our Secured Online Order page


Why PPACA - ERISA Appeal?



What Are Included with Your ERISA / PPACA Appeal Book?


Our ERISA / PPACA Appeal Book Is the Only Comprehensive and Practical CD Book in USA Not Only with pdf Book Teaching ERISA Basics and Appeal for All Common Denials, But Also with Digital Files for Turn-key ERISA Forms and Letters, Covering:


  • ERISA Basics, In Layperson's Language, Explaining Most Complicated ERISA Legal Principles, ERISA Statutory Provisions and ERISA Regulations;

  • Full Discussion On Department of Labor, DOL, FAQ and Guidelines, for ERISA Claims Regulation and SPD (Summary Plan Description) Regulation as well as Benefits Coverage Rules, Such as Preexisting Condition;

  • In-depth Discussion on Most Relevant Rulings from U.S. Supreme Court and Appeals Court as well as Federal District Court for Healthcare Providers;

  • Practical Discussion on ERISA Application and Appeal Strategies for All Commonly Seen Claims Denials and Appeals, Policy Exclusion and Limits, Medical Necessity, Down-coding & Bundling, Lack of Pre-certification, COB, Out-of-Network Denials, UCR (Usual, Customary and  Reasonable, Overpayment denial and Recoupment, and Many More......

  • Microsoft Word Files for All Necessary ERISA Appeal Forms and Letters, Such as ERISA Forms with  Legal Assignment Of Benefits (ERISA Power Of Attorney for Authorized Representative),  Legal Notice to Plan Administrator for ERISA Legal Assignment and SPD Request letter, SPD Request Letter and ERISA Notice For Plan Administrator to Send Reimbursement Checks to Out-of-network Providers (per U.S. Supreme Court Ruling on ERISA Assignment and Disbursement of Benefits Checks), and Hundreds of Digital Letters, Ready to Go, for all Common Claim Denials and Delays, Especially for Now Popular Overpayment Demand and Recoupment Disasters;

  • Our 2010 Major Updates Included All of Our 2010 PPACA Webinar Handout and Most Recent Federal Court Rulings on Overpayment Disputes and the Largest ERISA Provider Class Action in U.S. Legal and Healthcare History;

  • Our 2010 Major PPACA/ERISA Update Includes the Most ERISA Actual Appeal Letters used by Many Plaintiff Class Representatives to Win the Court Approval on ERISA Legal Standing (Right to Sue), ERISA Legal Arguments, ERISA Suit Against Most BCBS Entities;

  • Our 2010 Major PPACA/ERISA Update Includes Entire PPPCA Statutory Codes and Published Regulations from DOL, HHS and IRS;

  • Our 2010 ERISA Appeal Letters Have Incorporated PPACA Appeal Mandates and Most Recent U.S. Supreme Rulings, Federal court Ruling for Overpayment Disputes;  

  • Our 2010 ERISA Appeal Letters Actually Used for FBI, DOJ in Overpayment Appeals.....

  • And More...





Our PPACA / ERISA Apepal Book and System Comes with 15-days Free Support for How to Use the CD Book. Our PPACA /ERISA Cd Book Is Far From Perfect, But This IS the ONLY PPACA & ERISA Book Available in USA That is Only for Provider Healthcare Claim Appeals. This CD Book Has Been Used by Thousands of Providers and Coding / billing Reimbursement Professionals in the Past 10 Years, Even Federal Law, ERISA, Has Been Around for 35 Years since 1974, as the Only Federal Law Mainly Governing All Group Health Claims for More Than 176 Million Americans Each Year.


Along with's Web Site, Live Seminars, Webinars, ERISA On-Site Certification Programs and Corporate Compliance Programs, Fraud and Abuse Prevention Training, Dr. Jin Zhou, the Author of the PPACA / ERISA Appeal CD Book and President of, Has Been the only Pioneering Expert and Co. in USA in the Past 10 years to Demystify 35-year-old ERISA Law for Healthcare Providers, and Thousands of Legal Professionals to Use ERISA Law in Their Practical Appeals for Healthcare Claim Denials. Dr. Jin Zhou Has been Regarded as the Godfather for ERISA Claims for Providers by Many in the Healthcare Industry.


Now, PPACA on Top of ERISA Is Here, the Deadline Is Sept. 23, 2010, Dr. Zhou Is Fully Dedicated and Committed to Assisting All Providers In Timely Compliance with New Federal Health Reform Law, PPACA and Get Maximum Reimbursement Only For What They Legally Entitled to Under PPACA / ERISA and Plan Provisions.


Jin Zhou


630-808-7237 (Mobile)

630-736-2974 (Office)

630-736-1439 (Fax)





Other Books On Medicare Appeals


New Medicare Claims Appeals Process
CD Book
: $395
New IL WC Laws For Healthcare Providers (with New Forms)

CD Book: $275

Holiday Special -  Medicare New Appeal CD & IL WC CD: $460

[More info on CD Books]       [Order CD Book]








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 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.

Hanover Park, IL (PRWEB) June 28, 2010 – announced the nation’s first new Health Reform Law, PPACA, Claim Denial Appeal CD Book, for healthcare providers to meet the compliance deadline for Sept. 23, 2010, and to appeal claim denials and delays under new Health Reform Law, Patient Protection And Affordable Care Act, PPACA, going into effect on Sept. 23, 2010 for all group health plans and healthcare providers. Since HHS, DOL and IRS released the first set of Interim Final Rules on June 17, 2010 for implementing PPACA by Sept. 23, 2010, Federal government has practically initiated enforcement historical clock envisioned by President Obama. All healthcare providers, physicians and hospitals, without PPACA compliance by Sept. 23, 2010 will be found in violation of PPACA with unexpected claim denials by health plans under PPACA. According to the new PPACA Fact Sheet published by DOL, HHS and IRS, new PPACA will cover 193 million people, and PPACA mandates new PPACA (ERISA & NAIC) Appeal Process.


New Health Reform Law, PPACA, Claim Denial Appeal CD Book is published with 9 year success based on’s ERISA Appeal CD Book & System, as the only ERISA Appeal Book for health providers in the country in the past 35 years. The PPACA / ERISA Appeal CD Book is priced at $450 and available now from web site. The healthcare providers who used ERISAclaim’s ERISA CD Book appeal letters have won a recent major federal court decision in the largest historical ERISA provider class action lawsuit with court permission to proceed against almost all Blue Cross and Blue Shield Entities in the now popular overpayment recoupment dispute. The court affirmed all of the ERISA appeal legal points from the actual appeal letters, according to Dr. Jin Zhou, author of the Book and President of


The Court Case is Pennsylvania Chiropractic Association et al. vs. Blue Cross Blue Shield Association et al., Case #: 1:09-cv-05619, on May 17, 2010. A copy of the federal court ruling is available at:


A copy of the Press Release from the lead class plaintiff law firm is available at:


Dr. Zhou further explained that the SEC. 2719 of PPACA has adopted ERISA claim regulation, in its entirety, the 35 year old ERISA law and the “established process”, for PPACA internal appeal process, and NAIC Review Model as External Appeal Process that is binding for all health plans.


According to Dr. Jin Zhou, his company has been teaching weekly and monthly webinars on PPACA ever since PPACA was enacted on March 23, 2010, attended by professionals from every segment of the industry with great success.  There have been strong awareness and demand by hospitals for PPACA compliance by Sept 23, 2010, especially when hospitals are faced with new Medicare fee cut and increasingly disappointing reimbursement by managed care payers.


Dr. Jin Zhou also alerted all healthcare providers that Federal Government, DOL, HHS and IRS have issued new sets of regulations to implement and enforce PPACA, and PPACA federally mandates ERISA appeal process for all group health plans and healthcare providers. More new Federal Regulations are released at DOL and HHS web sites:


“Affordable Care Act Regulations and Guidance”



As Dr. Zhou noted from DOL, HHS & IRS PPACA Fact Sheet, The New PPACA on Sept. 23, 2010 will cover about 133 million people under self-insured health plans, 43 million under fully insured plans, and 17 million under individual market. A total of 193 million people will be governed under PPACA on Sept. 23, 2010, and an estimated 32 million more will be covered under PPACA by 2014. No hospital can afford to ignore 193 million people’s healthcare coverage and possible reimbursement, said Dr. Jin Zhou.


DOL Fact Sheet:  Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans (U.S. Department of Labor), June 14, 2010




HHS Fact Sheet: The Affordable Care Act's New Patient's Bill of Rights (U.S. Department of Health & Human Services), June 22, 2010




In the past 10 years in USA, has been the only ERISA Specialized Company offering the most practical and comprehensive ERISA education, consulting and publishing services for healthcare providers in administrative ERISA appeals for real problem oriented denials under the most mysterious 35-year-old federal law, ERISA. Dr. Jin Zhou, the President of has been referred to as “the Godfather of ERISA Claims” for providers in the healthcare industry.


For more information, please visit, or contact Dr. Jin Zhou, president of, at 630-808-7237.




Jin Zhou, President

Tel: 630-808-7237 (Mobile)

Tel: 630-736-2974 (Office)

Fax: 630-736-1439







Managed-Care Claim Delays & Denials? What Does the Unanimous US Supreme Court Say?


On June 21, 2004, an unanimous US Supreme Court ruled that claim processing (medical judgment, timely pay &  benefits determination)  and denials of benefits under the employer-sponsored health plans, ERISA-regulated benefit plans, for both self-insured and fully-insured (through purchase of insurance) health plans, are completely governed by federal law ERISA, that supersedes and invalidates state laws. - Supreme Court Managed Care ERISA Watch

Aetna Health Inc. v. Davila


Opinion of the Court


"Held: Respondents’ state causes of action fall within ERISA§502(a)(1)(B), and are therefore completely pre-empted by ERISA §502 and removable to federal court. Pp. 4–20."


"We hold that respondents’ causes of action, brought to remedy only the denial of benefits under ERISA-regulated benefit plans, fall within the scope of, and are completely pre-empted by, ERISA §502(a)(1)(B), and thus removable to federal district court. The judgment of the Court of Appeals is reversed, and the cases are remanded for further proceedings consistent with this opinion.7 It is so ordered."


"ERISA for Physicians:
Healthcare ERISA Claim Denials and Appeals

With 2004 Update



A System With

CD Book-more than 790 pages, and

Electronic version of all of the appeal letters found on CD book, and free technical support for CD book for 15 days, and

free appeal network support for 15 days


Please note that the new ERISA Authorized Representative Form/Legal Assignment for Benefits, with copyrighted materials, in complying with new ERISA claim regulation with respect to DOL FAQ B2 & B3, is available and included in our ERISA Claim Appeal CD Book and System.


The First ERISA Demystified Practical and Most Comprehensive Action Book for Health-care Providers, Physicians, Clinics and Hospitals.

  1. The First ERISA Demystified--- The First Book in U.S. History, Demystified Extremely Complicated Federal Law, ERISA, for Physicians in Plain English; The First System to Apply ERISA Secrets in Physicians’ Claim Appeals.

  2. Practical---- Most Powerful ERISA Appeal Letters, More Than 20 Appeal Letters Provided with Text Files for Streamlined and Efficient Appeal Practice.

  3. Most Comprehensive---- More Than 760 Pages on One CD Book, Including ERISA Statutes, Regulations, U.S. Supreme Court and Appellate Court Opinion Analysis As Well As New Federal Claim Final Regulations and More.......


"Only One Payment from Your Denied Claims
May Pay off the Seminar or Book Itself!
Why Not Take Actions to Save 40% of Your Business & Headaches?"


click here to view or download a Demo CD

(Adobe Reader 5.0 is required, best viewed with Bookmark on by pressing F5)


Table of Contents (Click Here)


Fax Order Form (Click Here)

Click here to enter our secured online order page


Free Update - ERISA Books & Appeal System

Last updated 03/06/2004


1 FREE 2003 Update: (PDF) Available for Download



FREE 2003 Update: (MS Word/Doc) Available for Download

Update in Compliance with New SPD and Claim Procedure Rules

3 FREE 2003 Update: (MS Word/Doc) Available for Download for

Bundling & Down Coding/PPO Discount under New ERISA Claim Regulation and Supreme Court Unanimous Ruling

4 Free 2003 Update, No SPD & "Not Plan Administrator"


5 Free 2003 Update: "Overpayment" Refund Request Response & Appeals (Doc)


6 Free 2003 Update: New  SPD Request Letter

Compliant with New ERISA Claim Regulation and HIPAA Rules, Important Update,

7 Free 2003 Upadte: ERISA Preservice Claim Form


8 Free 2004 Update "ERISA Quick Guides"


9 Free 2004 Update "ERISA Assigment Dispute" (09/16/2004)
  New 2006 Appeal Letters (09/28/2006)
  OverPayment Refund Appeal 2006
  Overpayment Refund Letter to A Collection Company (I) (II) (III)
  New 2006 Appeal Letters (10/04/2006)
  OverPayment Recoupment Appeal 2006
  New 2006 Appeal Letters (10/13/2006)
  OverPayment Recoupment Medical Necessity and Hearing 2006



New 2006 Appeal Letters (10/13/2006)

ERISA Appeal for Overpayment Refund Request due to Medical Necessity and New PPO Hearing


In accordance with U.S. Supreme Court decision in Aetna Health Inc. v. Davila on 06/21/2004, “Medical necessity” dispute or denial and subsquent overpayment request, is an ERISA plan retrospective administrative remedy, and any non-ERISA “causes of action, brought to remedy only the denial of benefits under ERISA-regulated benefit plans, fall within the scope of, and are completely pre-empted by, ERISA §502(a)(1)(B),......"

New 2006
Appeal Letters (10/04/2006)


Due to the increasing Katrina style of  plan OverPayment Recoupment or Recovery denials, when plans withhold or reduce countless subsequent or future plan approved claim payments by alleging recoupment or recovery for previously overpaid claims to providers, we have added to our ERISA Appeal Book & System the most powerful ERISA appeal letter (OverPayment Recoupmet Appeal 2006) based on all applicable U.S. Supreme Court rulings, 2432 Coercive or Fraudulent Interference with ERISA Rights -- 29 U.S.C. 1141  and new ERISA claim regulation as well as our practical experience and knowledge in ERISA appeal practice.

New 2006 Appeal Letters (09/28/2006)


We have added two new and updated appeal letters to our ERISA Appeal CD Book for increasing overpayment refund requests and disputes from health plans and commercial collection companies.


Our new and updated appeal letters are based on ERISA claim regulation on denials-adverse benefits determination, two new U.S. Supreme Court rulings in Aetna Health Inc. v. Davila on 06/21/2006  and Sereboff v. Mid Atlantic Medical Services on 05/15/200 as well as federal “Fair Debt Collection Practices Act”.


Pricing for copyrighted update letters: Free to anyone who purchased our ERISA Appeal CD Book in past 60 days (please email us for free password). $35 for anyone who purchased our ERISA Appeal CD Book prior to past 60 days. Who may use our online secured order page to pay for your order and password, then download the letters from our "Appeal Book & System Page". We do not sell these appeal letters separately from our ERISA Appeal CD Book ($450).


Medicare CD-Book - $250



Click Here or the CD-Picture to Enter

Our Secured Online Order page


Fax Order Form (Click Here)


Click Here to Download a Sample with Complete Table of Contents in Bookmark (pdf 1,095kb)

(Turn on Bookmarks to view Table of Contents)


While this CD book uses chiropractic specialty and Illinois as an example to illustrate Medicare coding and documentation, and it's impossible to describe every specialty and state local rules in a single book, this CD book has provided you with very specific hyperlinks to CMS/Medicare Medlearn provider specific materials in the beginning of the CD book and, in the end, a complete enclosure with all PDF files from CMS website for "Reference: Medicare Learning Network Products Catalog. This catalog provides a list of all available Medicare Learning Network products and a description of each product."


This CD book might be the most comprehensive coding and billing books with complete Medicare guidelines, instructions and regulations, containing all of the CMS provider educational books and manuals from Medicare Learning Network, from basic ICD and CPT selection to Correct Coding Initiative/CCI. This is the most comprehensive guidebook based on Medicare billing and coding, instrumental for all other claims and payers.


With a complete reference guide with all pdf files downloaded from CMS and hyperlinks to provider specific Information, this CD book shall be an extreme valuable learning and practical reference tool for every specialty and location.


1.       How to establish medical necessity through correct coding and documentation for expanded coverage under New Medicare guidelines, national and local policies;

2.       How to document medical necessity in accordance with Medicare Evaluation and Management Documentation Guidelines from CMS and WPS official publications;

3.       How to prove medical necessity by appropriately ordering diagnostic tests, such as MRI, or CT scans, in accordance with local Medicare LCD to support medical necessity beyond manual palpation and x-rays;

4.       How to obtain, understand and implement CMS “1997 Documentation Guidelines for Evaluation and Management Services”;

5.       How to obtain, understand and benefit from WPS publication: “Evaluation and Management Guidebook”;

6.       How to understand CMS/Medicare initiatives in “Fighting Fraud & Abuse” by enjoying expanded coverage through medically appropriate medical care and documentation without “analysis and paralysis” avoidance of Medicare new chiropractic demo practice;

7.       How to truly understand National Correct Coding Initiative (NCCI) to avoid fraud and abuse with official CMS publications in presentation and reference guide;

8.       How to understand WPS Medicare Part B - Illinois Policy on “Magnetic Resonance Imaging”;

9.       Most importantly, learn how to obtain through Internet, understand and educate yourself for all of these through official publications from CMS and WPS;


You shall always guide your practice based on the applicable official CMS publications with precise and correct understanding of subject matter. We will teach you how to search, download and understand all of these publications and specific guidelines from CMS and WPS.


Frequently Asked Questions


1.     Who Will Benefit from This Web Site and Services?

2.     Why is So Different?

3.     How to Effectively Use This Website?

4.     Legal Disclaimer




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 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.

  1. 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.


    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] []
The Office of Inspector General (OIG), Department of Health and Human Services
, June, 2001




Compliance Assistance for Health Plans




Statutes (United States Code) 
ERISA - Title 29, Chapter 18. 

        Selected links:

Sec. 1002.

Sec. 1003.

Sec. 1022.
Summary plan description
Sec. 1104.
Fiduciary duties

Sec. 1140.
Interference with protected rights

Sec. 1141.
Coercive interference

part 7
group health plan requirements



Code of Federal Regulations

Codified in Title 29 of the Code of Federal Regulations:


        Selected links:

2520.102-3 Contents of summary plan description.

Claims procedure.




ERISA Laws/Rules

ERISA in the United States Code: Cross-reference table, table of contents




ERISA Not Insurance

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"


Aetna ERISA Settlemnt with 950,000 MD's


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."



AMNews through  AMA

Health plans subject to new federal appeals rules
Much-postponed regulations offer patients and doctors fairer and faster review, plus new rights, Dept. of Labor says.














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