New Federal Health Claims & Appeals Laws
for 193 Million Americans
Obama Signing Health Bill on 03/23/2010
Gerald R. Ford Signing ERISA on 09/02/1974
New Webinars, Seminars &
Certification Classes Announced for New Federal Health Claim Appeals
Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept.
23, 2010 for 193 Million Americans
DEPARTMENT OF LABOR
(Links to DOL)
©2010, Jin Zhou, ERISAclaim.com
Statutory Laws [PDF]
Employee Retirement Income Security Act ERISA
Webinars, Seminars & Certification Classes for New Federal Health
Claim Appeals Regulations
Free Webinars - New Federal Claims & Appeals Regulations, Effective
Sept. 23, 2010, for 193 Million Americans
ERISAclaim.com: Seminars -
2011 Two-day Basic ERISA Appeal Seminars - Denials and
ERISAclaim.com - 2011
PPACA & ERISA Claim Specialist Certification Programs in
Create An Appeal Department for Your Hospital or Practice
(In-house, onsite ERISA Claim Specialist Certification Programs)
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We're not employees
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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.
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
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Frequently Asked Questions
Who Will Benefit from This Web
Site and Services?
Why is ERISAclaim.com So
How to Effectively Use
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
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
Why is ERISAclaim.com So
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.
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.
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"
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."
$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.