ERISA - EMPLOYEE RETIREMENT INCOME SECURITY ACT
WAIT - IT'S NOT WHAT YOU THINK
When most people see the "retirement" and "security" in the name of the ERISA law - they think "oh - it applies to securities and investments and that stuff - and it does - but that is NOT what affects EVERY medical office, every clinic, every hospital and every medical biller. The Medical side of ERISA is amazing.
THIS AFFECTS ME?
When an employer provides health insurance to an employee - it falls within the "compensation" arena, the same way the salary, vacation, holidays, overtime, etc. does.
This means the patient and insurance policy is NOW protected by the federal government and the 1974 ERISA law - which is a GREAT thing for medical providers, hospitals and clinics.
ALL INSURANCE CLAIMS PROVIDED BY EMPLOYERS?
About 83% of ALL non Medicare and non Medicaid medical claims fall within the ERISA purview. If the insurance is provided by a non government or non church employer, the policy is ERISA.
That's a good thing for you and the patient as it gives the patient's policy more protection. This means people working for Walmart, Exxon, Mobil, Carrier, Fedex, and every other non church and non government employer have ERISA policies!
HOW DOES THIS AFFECT MY CLAIMS?
Contrary to what you thought - YOU don't have any claims. It's NOT your policy and it's NOT your claim. It is the PATIENT'S claim - and that is great news for you as that claim is protected by the Department of Labor, whereas if it was YOUR claim - it would have zero protection.
DOESN'T STATE INSURANCE LAWS HELP?
If it's an ERISA claim, then the state insurance laws do NOT help and they do NOT apply. The federal protections take precedence over state laws, state insurance regs and even the contract you may have been dumb enough to sign with the carrier. Your contract cannot interfere with the federal protections that claim has.
HOW DOES ERISA AFFECT ME?
You "think" you have a timely filing limit of 90 days or 120 days with a carrier.
That claim, that belongs to the patient, that you filed does NOT have that timely limit. Your contract with the carrier means NOTHING since the patient's policy is ALL that matters and most patient policies have 180 days or 1 year and some even have 2 years.
95% IN MEDICAL FIELD KNOW NOTHING OF ERISA
Insurance carriers are counting on the fact that less than 5% of people in medical offices or hospitals know anything about ERISA.
They know they can't legally recoup -but they do it anyway. They know the timely filing limit in your contract means nothing on more than 80% of the claims you file to them - but they know that most medical offices and hospitals are ignorant of that fact.
YOU SAID THEY CAN'T RECOUP?
The claim is NOT your claim. It's the patient's claim - and therefore it's the patient's money. The Supreme Court has ruled several times that if the carrier wants money back - they have to get it from the patient - and NOT the medical provider.
The fact they mailed the check to you means NOTHING - regardless of the lies told to you by the insurance carrier in the letter they send you full of false information.
BUT THEY RECOUPED FROM ME ANYWAY
Of course they did. They banked (literally) on the fact that you were ignorant about ERISA - yet you could have stopped them from getting an insurance carrier refund from you very easily.
It's probably not too late to get them to refund to you the money they recouped. They don't want to be sued like BCBS did. That case ended up with the carrier paying more than $350 Million - and they don't want to pay that again.....
WHAT ELSE DOES ERISA AFFECT?
- ERISA can make the carrier pay when they don't want to.
- ERISA can stop the carrier from down-coding the claim anytime they wish.
- ERISA can stop the carrier from making up ridiculous bundling policies.
- ERISA can stop a carrier from claiming a service is investigational or experimental,
- and more
HOW CAN I LEARN MORE?
You can watch a free 10 minute video on ERISA on Youtube.
You can order a printed book or the same book in pdf in our web shop.
You can download a very popular one hour webinar movie (with the pdf slides) on ERISA that you will have on your computer and let everyone in your office watch it anytime you wish to.
HOW DO I KNOW THIS WORKS?
GREAT QUESTION! Look below at the comments from people you may know - who have attended our ERISA webinars or bought our books and used that data to make carriers play by the rules
If you want to verify any of these - just ask and we'll give you their email address if it's not shown below.