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2012: Patient’s (Doctor’s) Bill Of Rights – PPACA & ERISA Outlaws Anti-Assignment by Insurance Companies

2012: Patient’s (Doctor’s) Bill Of Rights – PPACA & ERISA Outlaws Anti-Assignment by Insurance Companies











Hanover Park, IL (PRWEB) December 31, 2011

ERISAclaim.com announces 2012 Webinars on Patient’s (Doctor’s) Bill Of Rights under health reform laws for claims denials, delays and overpayment crisis. PPACA claims regulations will be fully enforced in 2012 by adopting 36-year-old federal law, ERISA, in its entirety with new protections for patients, doctors and hospitals. PPACA & ERISA Outlaws 36-year-old discriminative anti-assignment practice by all insurance companies and managed care entities, with a new definition of claimant under PPACA, making all doctors and hospitals with valid PPACA and ERISA assignments equally protected under PPACA, also known as “Doctor’s Bills of Rights”, regardless of providers PPO network participation. ERISAclaim.com’s Doctor’s Bill of Rights Webinars starts at $ 5,000 for each two-hour session for each organization.

On November 10, 2011, for the first time in U.S. healthcare history, as a part of PPACA enforcement, federal government launched a “Federal Insurance Department Website” for both patients and providers. On March 16, 2011, Congressional GAO published a report indicating that less than 0.5% of denied claims were appealed in the State of Ohio while 39 to 59% of appeals reversed denied claims.

“While Supreme Court is scheduled in March 2012 to review the constitutionality challenge on PPACA, on May 16, 2011, the Court significantly redefined ERISA with new remedies and protections for patients and providers by its decision in Cigna v. Amara (Case #: 09–804). Regardless of the Supreme Court decision on individual coverage mandate, PPACA claims regulation is completely based on ERISA claim regulation, the 36-year-old federal law, completely governing all employer-sponsored health plan claims,” said says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

According to DOL data, about 77% of insured Americans under employer-sponsored plans have purchased out-of-network coverage by paying higher premiums, out of network doctors and hospitals are completely powerless without PPACA and ERISA compliance if any patients wanted to exercise their rights to see out-of-network doctors and hospitals, warned Dr. Zhou.

ERISAclaim.com’s “Doctors’ Bill of Rights Webinars” will cover following topics with in-depth analysis and compliance of PPACA and ERISA ($ 5,000/2 Hr session/private only):

1.    PPACA “Patient’s Bill of Rights” aka “Doctors’ Bill Of Rights:

http://cciio.cms.gov/programs/marketreforms/billofrights/index.html

“On June 22, 2010, President Obama announced new interim final regulations, the Patient’s Bill of Rights, that include a set of protections that apply to health coverage starting on or after September 23, 2010, six months after the enactment of the Affordable Care Act.”

2.    DOL Affordable Care Act Regulations and Guidance: http://www.dol.gov/ebsa/healthreform/

3.    PPACA Regulations on Internal Claims and Appeals and External Reviews:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=5a02ffcbdc3b299526312c6fe4f889f8&rgn=div8&view=text&node=29:9.1.3.12.14.3.20.9&idno=29

4.    EBSA News Release: US Department of Labor’s EBSA creates new consumer assistance Web page [11/10/2011]

http://www.dol.gov/opa/media/press/ebsa/EBSA20111627.htm

5.    “Federal Department Of Insurance Complaints Website” for Doctors and Patients: https://www.askebsa.dol.gov/WebIntake/Home.aspx?submit=Submit+a+Complaint

6.    Congressional GAO Reports: 39% to 59% denial reversal with valid appeals, only 0.5% appeals in Ohio – http://www.gao.gov/new.items/d11268.pdf

7.    DOL: About 77% of Insured Americans Purchased Out-Of-Network Coverage under Private Industry (DOL, BLS, NBS 2010, page 11 of 167): http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf

8.    How to become a compliant claim expert in Doctor’s Bill Of Rights under PPACA and ERISA, to appeal all wrongful denials and delays for medical necessity, policy limitation, billing coding errors and out-of-network choices and a direct insurance payment.

In addition, ERISA Outlawed anti-assignment practice since January 1, 2003:

http://www.dol.gov/ebsa/regs/fedreg/final/2000029766.pdf (page 70255)

“The proposal eliminated a provision in the 1977 regulation that seemed to imply that representatives of a claimant must be “duly authorized” to act on behalf of the claimant. This change reflected the perception of the Department that no single Federal standard governs the authorization of a representative and that claimants should be able to freely name representatives to act on their behalf…..Specifically, subparagraph (b)(4) provides that a plan’s claims procedures may not preclude an authorized representative (including a health care provider) from acting on behalf of a claimant and further provides that a plan may establish reasonable procedures for verifying that an individual has been authorized to act on behalf of a claimant. …\ This provision, which is a clarification of current law, applies to all employee benefit plans covered under the Act.”

Most importantly, PPACA “Doctor’s Bill Of Rights” redefined “Claimant” for equal protections under Patient’s Bill of Rights:

http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056 (page 43355)

“(iii) Claimant. Claimant means an individual who makes a claim under this section. For purposes of this section, references to claimant include a claimant’s authorized representative.”

To find out more about the Total PPACA Claims and Appeals Compliance Services from ERISAclaim.com:

http://www.erisaclaim.com/Press_Releases.htm

Located in a Chicago suburb in Illinois, for over 11 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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Posted on January 16, 2012 by , 1 comment

What Constitutes Adequate Insurance Coverage?

A common question that people ask in insurance circles is regarding what constitutes adequate insurance coverage. It is an understandable question, seeing the number of insurance products that the average person shopping for insurance policy is likely to be presented with by the insurance vendors – followed by a pitch meant to make every product look essential. All insurance products, of course, cost money – and many people, in the spirit of financial prudence would naturally rather not spend money on insurance products that they really don’t need. At the same time, while being financially prudent with the money they spend on insurance premiums, many of us are wary of spending too little (and thereby buying up too little coverage), resulting in inadequate benefits on the occurrence of the risky event we are insuring against.

So what really constitutes adequate insurance coverage?

Well, the answer as to what really constitutes adequate insurance coverage will vary from person to person- but the constant which holds in all cases is that ‘adequate insurance coverage is that which allows for reasonable peace of mind.’

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While some of us purchase insurance because it is a statutory requirement in some cases (like in the case of motor vehicle insurance), or because it is fashionable (if everyone at the office is buying it), the real prudent reason that anyone should invest in insurance policy is the peace of mind that having insurance coverage offers. And in the same spirit, adequate insurance coverage is that in which you can have adequate peace of mind in knowing that you (or your family) are adequately covered in the event of whatever risk the policy covers actually taking place.

In the case of life insurance, for instance, adequate coverage can only be described as that in which the person taking it can live with the peace of mind of knowing that their loved ones will be adequately provided for (with money from the policy) in the event of them (the policyholders) passing away at some point.

And in the case of medical insurance, adequate coverage can only be described as that which gives the person taking it the peace of mind of knowing that should any form of illness befall them, they can be sure of getting the best medical attention possible, without financial limitations coming on the way to getting such attention.

In this discussion, it is important to note that not every insurance coverage package on the market offers complete peace of mind. In a bid to offer ‘affordable’ products, insurance companies are often forced to cut down on the levels of benefits they offer – sometimes translating into levels of coverage that realistically speaking, don’t guarantee much peace of mind, as the policyholder is really only ‘halfway covered.’ It is therefore essential to go through an insurance policy’s fine print – to see the real benefits it offers and whether they present real peace of mind – before investing in it.  Bad Credit credit cards

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Posted on August 27, 2011 by , Reply

Mandate to buy health insurance might not be constitutional

The individual mandate to buy health insurance is a key part of the Democrats’ health-care plan. Their package, if they can pass it now, doesn’t work without the mandate. But is it constitutional?

Sen. Patty Murray, a Democrat, who has been working to pass it, said it is, easily. “We have done it before,” she said, noting that Social Security, which is federal, is mandatory insurance.

But when it came to the Supreme Court in 1937, Social Security was approved as a tax and a spending program. A single-payer plan might be approved that way, but not the current plan. This is mandatory private insurance.

Requiring people to buy that, former Sen. Slade Gorton, a Republican, told me, is “clearly and blatantly unconstitutional.” He immediately sanded down that statement, however, by saying the Founders would have thought it so. Today’s Supreme Court would split on it, he said, and “it will probably be Justice Kennedy who decides it.”

The argument against the mandate is that it exceeds the powers of Congress. The Constitution lists these powers in Article 1, Section 8, from declaring war and fighting pirates to imposing taxes, borrowing money and running the Post Office. They describe a small government. It has grown large by stretching one thing on the list, the power “to regulate Commerce … among the several States … ” This has been interpreted to cover all activities that affect commerce, from racial discrimination to growing marijuana to a hundred other things.

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As it said “yes” to federal power, one claim at a time, the Supreme Court kept saying there was a limit. There had to be, otherwise the commerce power would swallow up all the others and federal power would be unlimited. But in 75 years the Supreme Court has only twice said a law exceeded that limit: a gun law and a rape law. Both cases were decided 5-4, with the swing vote Justice Anthony Kennedy’s.

Now comes the mandate to buy health insurance. “The question,” said attorney David Rifkin, who spoke to the Federalist Society in Seattle last fall, “is how to shoehorn this into the Constitution.”

For some, it is easy. Stewart Jay, who teaches constitutional law at the University of Washington School of Law, and has written several histories on constitutional law, said: “Congress is allowed to regulate economic activity, and buying insurance is an economic activity.”

Case done.

Rifkin, of Baker & Hostetler, Washington, D.C, said, “there is something really weaselly about that argument.” The commerce power has always been about regulating an activity. And Rifkin said, “Is refusing to purchase insurance an activity?”

Attorney General Rob McKenna is among a group of Republican state attorneys general who may challenge the individual mandate on just that point.

“My opinion,” said McKenna, “is that it isn’t clear where the federal government would derive its authority to force individuals to buy health insurance. These are individuals who have chosen not to participate in commerce.”

I like McKenna’s argument because I like where it goes. I don’t want government to tell me how to spend the money I have left over after paying taxes. The state government may do it — with car insurance, for example — and that’s enough for me.

The Supreme Court could go either way on this. In the end, it comes down not to who’s “right” about the law, but about what people want.

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Posted on July 25, 2011 by , Reply