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.
There have been urgent and popular market demands for ERISA healthcare claim appeal as the ERISA law, rather than billing, coding and managed care contract, completely governs denial of benefits per U.S. Supreme Court in Aetna v. Davila, for 170 million civilian working Americans and their families. Failure to appeal by doctors and hospitals for denied claims is the one of the main reasons for more and more middle-class bankruptcies when 77.9 percent of those bankrupted by medical problems had health insurance at the start of the bankrupting illness, including 60 percent who had private coverage from ERISA plans in this $6 trillion healthcare denial management market.
More and more class action lawsuits have been filed recently under ERISA and RICO on behalf of doctors and hospitals for overpayment disputes in order to avoid provider’s financial disasters and bankruptcies, however, ERISA law requires the plaintiff to completely exhaust ERISA appeal remedies before filing any lawsuit in Federal Court. Multi-billion dollars have been reportedly recouped by Payers and managed care TPA’s in private sector, in addition to now popular Medicare RAC overpayment program.
ERISAclaim.com is currently the only company in the country that provides comprehensive, systematic and advanced ERISA healthcare claim education, consulting and publishing primarily for the healthcare providers and industry consultants.
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. It 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.
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. He has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers and assisting trial lawyers frequently for more than 10 years. Dr. Jin Zhou was sometimes referred to as the "Godfather of ERISA Claims" for healthcare providers by some industry experts. His ERISA expertise and experience are unique and different from that in traditional ERISA appeal and litigation for disability claims on behalf of patients instead of healthcare providers with billing and coding, medical necessity and managed-care contracting and network complications.
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