|
|
|
|
 |
|
 |
|
ATTENTION ACA MEMBERS ATTENTION ACA
MEMBERS
Need to Know About The New ERISA Claims Regulations?
Purchase the Audiocassette from ACA’s phone
conference,
"ERISA Claims and Appeals" and Get the Facts You Need
|
|
Effective July 1st, the Department of
Labor adopted new regulations regarding ERISA that provide the consumer
and provider with new tools to fight managed care and other types of
plans that discriminate against the chiropractic profession. The
regulations, which went into effect despite strong opposition from the
managed care industry, require greater disclosure of claims procedures,
more procedures intended to assure full and fair review of claims from
plan participants and more definite time frames and procedures to assure
timely reviews of initial claims and appeals of denied claims. If
properly followed, the new rules would give doctors the ability to file
claims appeals for patients, to find out why a claim is being denied,
the policies and protocols used |
|
in the review of claims and the
identify of the experts used in the review of a denied claim.
This ACA live teleconference will provide you with the facts you
need to know about these new ERISA regulations and how individual
providers can make use of them.
The Speakers:
Dr. Jin Zhou, Dr. Spyros Bakis and Mr. Tom Daly, ACA’s
Legal Counsel will provide you with the information you’ll need to know
about new standards and regulations for processing ERISA benefit claims.
Jin Zhou, DC is an expert on the ERISA issue and is the author of the
book, ERISA For Physicians: ERISA Health Care Claim Denials and Appeals.
|
|
Fill out the
fax back order form and
fax to 703-243-2593.
Click here
for an Order Form (pdf)
ACA. Your
Solutions Start Here.
|
|
Order Form |
|
❒ Please send
me the audiocassette of the live audio teleconference.
____ $39 for ACA Members;
_____ $65 for Non-Members
ACA Membership #_____________________
Name ________________________________
Address ______________________________
City _________State _____ Zip___________
Day Phone _______Evening Phone________
Fax___________Email address___________
Fax your completed form to ACA Headquarters at (703) 243-2593, or mail
to: ACF, 1701 Clarendon Blvd., Arlington, VA 22209, or call (800)
986-4636
Click here for
a downloadable Form (pdf) |
|
❒ Check enclosed, for $
_______payable to the American Chiropractic
Foundation (ACF).
❒ Bill my credit card for $ _______using the information below.
Credit card
❒ Visa ❒ Mastercard ❒ Amex ❒ Discover
Credit card #___________Exp. date____
Cardholder signature ________________
Questions
call 1-800-986-4636
|
|
|
|
|
|
Associations for Physicians, Hospitals, Health-care Providers
We are willing to work with any associations with your co-sponsorship
and significant discount for tuitions and reference books. You may
e-mail or
telephone for more details. |
|
|
|
|
|
|
Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected links:
2520.102-3 Contents of summary plan description.
2560.503-1
Claims procedure. |
|
|
 |
|
$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.
|
|
|
|
|
$37,350 ERISA Claim
|
| Health-care provider alleged medical claims
submitted to Aetna for reimbursement, Aetna asserted no receipt
of medical claims, no written denials. Health-care
provider failed to present proof of claim submission, claim
denial and ERISA claim appeals. This case was dismissed. ERISA
health-care claims are handled in federal court, state law is
generally not applicable.
|
|
|
|
|
