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Moukawsher & Walsh, LLC
Pension and Employee Benefit Law


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  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2
US Supreme Court Visits

at 11:57:03 AM on Friday, November 21, 2003

New Federal Health Claims & Appeals Laws & Regulations

for 193 Million Americans

Effective 09-23-2010

©2010, Jin Zhou,

Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill on 03/23/2010

President 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

DOL Seal - Link to DOL Home Page



(Links to DOL) ©2010, Jin Zhou,

Patient Protection and Affordable Care Act

Statutory Laws [PDF] [PDF]



Employee Retirement Income Security Act — ERISA


Health Claims Related Information

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 Seminars - 2011 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals - 2011 PPACA & ERISA Claim Specialist Certification Programs in Chicago, Illinois  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)


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. 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.


    Although 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 claims dispute or compliance, those  law firms  or companies advertising on are not affiliated with or employed by or with disclaims any and all responsibility or liability for the accuracy, content, completeness, legality, reliability, or operability or availability of information or material displayed or advertised on the disclaims any responsibility for any harm resulting from downloading or accessing any information or material on the Internet linked to or through the

    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



Privacy and Security Statement


Thank you for visiting the and reviewing our privacy and security statement. is strongly committed to maintaining the privacy of your personal information and the security of our computer systems. With respect to the collection, use and disclosure of personal information, makes every effort to ensure compliance with applicable Federal and State laws.


As a general rule, the does not collect personally-identifying information about you when you visit our site, unless you choose to provide such information to us. The information we receive depends upon what you do when visiting our site.


If you respond to an on-line request for personal information:


Generally, the information requested by the will be used to respond to your inquiry or to provide you with the service associated with the request. However, when this information is requested, the reasons for collecting it with a description of the intended use of the information will be fully described in a customized "Privacy Notice." This Privacy Notice will either appear on the Web page collecting the information or be accessible through a link prominently displayed immediately preceding the information request.


If you visit our site to read or download information, we collect and store the following information:


  • The name of the domain from which you access the Internet (for example,, if you are connecting from the Department of Labor's computer account).
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The above information is used by software programs on our Web site to create summary statistics which allow us to assess the number of visitors to the different sections of our site, identify what information is of most and least interest, determine technical design specifications, monitor system performance, and help us make our site more useful to visitors.


If you identify yourself by sending an e-mail containing personal information:


You also may decide to send us personally-identifying information, for example your mailing address, in an electronic mail message requesting that information be mailed to you. Information collected in this manner is used solely for responding to requests for information or records. We do not forward or sell your e-mail to any third party.


If you link to other sites outside


Our Web site has many links to other sites. When you link to any of these sites, you are no longer on our site and are subject to the privacy policy of the new site.




For security purposes and to ensure that this service remains available to all users, our Web site also employs software programs to monitor network traffic to identify unauthorized attempts to upload or change information, or otherwise cause damage. You are hereby notified that use of this site constitutes consent to such monitoring and the above captioned "Legal Disclaimers" as well as our "Privacy and Security Statement".

If you visit our site, we collect and store the following information only: the name of the domain from which you accessed the Internet (e.g.,; the IP address from which you accessed this site; the date and time you accessed the site; and the pages you visited.

Unauthorized attempts to upload information or change information on this service are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1986 and The National Information Infrastructure Protection Act of 1996. Unauthorized modification of any information stored on this system may result in criminal prosecution.


The author and publisher of is not responsible for the creation or maintenance of web sites linked to this site, and does not vouch for the accuracy, completeness, or currency of any of the materials included on them.



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?




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.


The Root of U. S. Healthcare Crisis

Jin Zhou,

The Hearing at Senate Committee on Finance on 3-3-04, [View Video "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
or Transcript (PDF) (]  revealed the mechanism, nature and extent of ERISA failure and nonenforcement as the reasons for "Growth in Bogus Health Insurance Plans Targeting Desperate Small Business Owners", as being concluded as "No the results are not good. It’s a tragedy." by Ann Combs, assistant secretary of DOL. The mechanism, nature and extent of ERISA failure and nonenforcement as presented at the Hearing are universally true and applicable to all health care claim denials and delays in managed care environment from all employer sponsored health plans as the root of U. S. healthcare crisis.


This is a 911 call on "healthcare 9/11 disaster"!



ERISA & Claim Denials

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 & Health Claim
What Is 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."


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."



$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.



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