Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians
ERISA - EMPLOYEE RETIREMENT INCOME SECURITY ACT
WAIT - IT'S NOT WHAT YOU THINK
ALL INSURANCE CLAIMS PROVIDED BY EMPLOYERS?
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?
ALL INSURANCE CLAIMS PROVIDED BY EMPLOYERS?
WAIT - IT'S NOT WHAT YOU THINK
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?
ALL INSURANCE CLAIMS PROVIDED BY EMPLOYERS?
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?
DOESN'T STATE INSURANCE LAWS HELP?
ALL INSURANCE CLAIMS PROVIDED BY EMPLOYERS?
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?
DOESN'T STATE INSURANCE LAWS HELP?
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?
DOESN'T STATE INSURANCE LAWS HELP?
DOESN'T STATE INSURANCE LAWS HELP?
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.
DON SELF & ASSOCIATES, ERISA DIVISION
LET US STOP THOSE REFUND DEMANDS
Don Self and Associates announces a new division working directly with ERISA-related claims. Joseph Self, current Director of Operations is named Head of Department.
You're tired of carriers recouping from other claims. You're tired of carriers sending you recoupment demands telling you to write them a check. DSA-ERISA has a solution to stop the leak of cash flow.
DSA-ERISA currently has a limited number of slots available as partner clinics. These clinics will have the ability to send qualifying recoupment demands or previously performed recoupments to DSA-ERISA to allow us to coach you through the procedure to have these demands dropped, or previously recouped monies returned to you.
Fee for service to DSA-ERISA is on a success-based model at 25% of the claim amount, recouped or recovered recoup. This means you only pay when we save you the money and only 25% of what we save you.
If you're interested, keep reading.
As you know from reading my book, The Unfiltered Guide to ERISA for Medical Providers, carriers are required to follow certain claims procedures and follow certain requirements in regards to denials, adverse benefit determinations, timelines, and more. Due to ERISA there have been several Supreme Court decisions that have set precedent for how carriers must request money or "recoup" money they deem owed back to them.
In the most basic form, a claim ALWAYS belongs to the patient, you're just the "middle-man" that is filing the claim for them, regardless of what your assignment of benefits says or your contract with an insurance carrier. This is how it's mandated in federal law CFR 2560-503-1 in ERISA. It goes on to say that no contract or agreement can attempt to overwrite or contradict the Act. What this means is if a carrier pays for a claim, and retroactively issues an adverse benefit determination, they must follow certain notification guidelines, as well as, they must request the money back from the claimant, not the provider that performed services for the claimant.
IMAGINE THIS: The carrier sent the check to the patient and the patient cashed it at the bank and a few days later, brought cash to your office and paid their bill on the services you provided them. Six months later, you get a letter from the insurance company saying “We want that money that the patient brought into your office six months ago”. You would laugh at them!
The above scenario is what happens thousands of times a day, and we're done sitting around watching people get taken advantage of. Let's get to work.
