Committed to Compliant Education for Medical Claim Dispute Resolution
Hanover Park, IL, October 12, 2009 -- For the first time in U.S. healthcare history, ERISAclaim.com is offering the nation's first eight-day certification program for ERISA Claim Appeal Specialist, starting from January 14-15, 2010, in Chicago Illinois, for healthcare providers, managed-care third-party payers (TPA), benefits administrators and healthcare attorneys as well as the state regulators.
ERISA, Employee Retirement Income Security Act of 1974, is a federal law that governs and regulates healthcare claims for estimated more than 170 million Americans who obtained health insurance or benefits from employment in private sector, for both self-insured and fully-insured (through purchase of insurance) health plans. ERISA law completely (100%) preempts, supersedes and invalidates any and all state laws and private managed-care contracts for PPOs and HMOs in any and all dispute over denial of benefits from an ERISA plan. ERISA regulates and governs healthcare claims which include the paid ERISA healthcare claims in more than 50% of $2.4 trillion, 16.6% of GDP, of the national health expenditure in 2008, and also include the denied healthcare claims, legitimately or wrongly for appealable claims, in more than 50% of $5 trillion in the aggregated denied healthcare claims in 2008. More than 60-70% of healthcare claim denials from insurance companies and managed-care third-party payers by employer-sponsored plans are due to ERISA regulated plan or policy coverage, limitations and exclusions rather than traditional billing, coding, medical necessity and managed care contracting or participation dispute. Although in the past 35 years the notices for ERISA rights to appeal were written on almost every EOB (Explanation of Benefits) in the daily practice in doctors' offices and hospitals, the healthcare providers, managed-care third-party payers, and even legal professionals as well as the state regulators rarely understood how to conduct, manage or regulate ERISA claim appeals for ERISA claim denials and disputes.
The current Obama healthcare reform, regardless which version will prevail, will increase ERISA coverage from current 74% of civilian workers covered with health insurance under ERISA (as of March 2009) to 100% covered civilian workers, to cover, as early as next year, estimated more than 230 million civilian workers and their families. And the new Obama Department Of Labor (DOL) has sworn in to change federal ERISA enforcement from Bush's symbolic, "no teeth", ERISA voluntary compliance assistance to strike-force, "New Sheriff", ERISA enforcement on ERISA claim regulation, for healthcare claims from employer-sponsored and new federal mandated health plans for more than 230 million Americans.
There have been urgent and popular regulatory needs and market demands for ERISA claim compliance education and training in this $6 trillion healthcare denial management market.
ERISAclaim.com is offering the nation's first systematic, comprehensive and advanced eight-day ERISA Certification Program for ERISA Claim Appeals Specialist, starting from January 14, 2010, in light of increasing managed-care claim denials and delays from commercial payers and managed-care third-party payers and new explosive litigations under ERISA and RICO on behalf of healthcare providers in an era of skyrocketing healthcare costs in the midst of unprecedented economic recession, and in making U.S. healthcare history by teaching and training in this most important Federal law for healthcare providers, managed-care third-party payers (TPA), benefits administrators, healthcare attorneys and the state regulators, in accordance with U.S. Supreme Court rulings in Aetna v. Davila and ERISA claim regulation.
ERISAclaim.com is currently the only company in the nation that provides comprehensive, systematic and advanced ERISA healthcare claim education, consulting and publishing primarily for healthcare providers, the key players for the quality and costs of healthcare system in America, and their counterparts, plan sponsors, healthcare claim payers and TPA's, industry consultants, the key partners, and the state regulators . When ERISA, as a part of federal law for 35 years, was the most misunderstood governing laws for healthcare claims for more than 50% of $2.4 Trillion U.S. Healthcare expenditure each year, this ERISA law might be the most complicated but most important law in the United States.
"If ‘ERISA Miranda's Rights’ to appeal for every medical claim denial is on every insurance denial notice daily in doctors' offices and hospitals for 35 years since 1974 when ERISA law was enacted in Congress, and according to U.S. Supreme Court nine justice unanimous decision, ERISA is the only correct way to go for denied medical claims with employer-sponsored commercial plans, regardless of HMO or PPO, and for more than $1.2 trillion paid ERISA claims each year and more than least $3 - 4 trillion in denied ERISA claims, why can't our talented and dedicated healthcare and managed-care professionals do what Congress intended, Supreme Court instructed and each daily denial notice explained, "ERISA Miranda's Rights" to appeal?", said Dr. Jin Zhou, the president of ERISAclaim.com.
To resolve daily medical claim dispute, waste and inflation, which is debilitating and bankrupting U.S. healthcare system, to solve current U.S. Healthcare crisis and to succeed the Obama healthcare reform to cover 93% of Americans, Dr. Jin Zhou suggested that the compliant ERISA benefits administration and ERISA appeals by all parties are the best ways to guarantee the success of Obama healthcare reform for a new healthcare system in America, to reduce, minimize and eliminate unnecessary healthcare wastes and costly and lengthy litigations, as the most important way of healthcare reform as originally intended by Congress since 1974, to truly reduce skyrocketing healthcare costs in USA. The healthcare cost inflation and waste are similar to the traffic accidents as the real risks to our lives, societal and financial stability as well as our national security. With voluntary traffic law compliance by the drivers and with meaningful enforcement by our government, we can expect to live in a reasonable safe public transportation environment. Without traffic law compliance by all drivers, we will be living in a very dangerous environment. By the same token, without ERISA claim appeal compliance by all parties and meaningful enforcement from the federal government, we cannot expect to enjoy any basic healthcare claim honesty, efficiency, fairness and security in reducing healthcare inflation and waste in protecting U.S. economy and national security.
ERISAclaim.com advocates for compliant ERISA appeals as administrative remedies before any litigations by healthcare providers and patients to avoid any costly and lengthy litigations. ERISAclaim.com is committed to compliant education for medical claim dispute resolution. Our ERISA knowledge and expertise are unique and different from that in traditional ERISA appeal and litigation mainly for the disability claims on behalf of patients instead of healthcare providers with complications in billing and coding, medical necessity and managed-care contracting and network participation dispute. Dr. Jin Zhou, the president of ERISAclaim.com, was sometimes referred to as the "Godfather of ERISA Claims" for healthcare providers by some industry experts,
For more information or to arrange an interview, please visit www.ERISAclaim.com, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237 or ERISAclaim@aol.com.
# # #
ERISAclaim.com, located in northwestern suburb of Chicago, Illinois, is an online publisher, consultant and educator for ERISA claim education, training and consulting as well as claims recovery for ERISA healthcare claims. ERISAclaim.com also provides ERISA litigation support, research assistance and fraud and abuse prevention as well as PPO auditing defense consulting. In addition to ERISA, ERISAclaim.com also provides consulting and education for Medicare Claim Appeals Specialist, for Medicare RAC overpayment appeals, fraud and abuse prevention. It has more than 10 divisions,. website publishing, seminars, consulting, certification programs, litigation support & more.
Dr. Jin Zhou, the president of ERISAclaim.com, developed the nation's first ERISA education and practical appeal system for healthcare providers 10 years ago, and has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers for more than 10 years.