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Health Reform for Out-Of-Network Providers: Receiving Insurance Checks Directly? - Free Webinars on Why and How
Date:4/5/2010

the webinar attendees and increasing demand from non--participating providers for such topics, as result of recent announcement from many major insurance companies that no insurance reimbursement checks will be sent to out-of-network providers.

The webinars will cover very specific provisions, §2719 and §2706, of new healthcare reform law, Patient Protection and Affordable Care Act, PPACA, in reference to mandatory compliance with the established ERISA claim regulation in its entirety, ERISA §2560.503-1 for every group health plan an individual plan. ERISA §2560.503-1 (b)(4) prohibits any anti-assignment practice and discrimination by any group health plan in refusing to disburse benefits checks with valid patient assignments. Department of Labor, DOL, issued enforcement guidelines, DOL ERISA FAQ, B3, in explaining plan administrator's fiduciary duties in compliance with ERISA assignment requirement. United States Supreme Court ruled on January 26, 2009 in Kennedy v. Plan Administrator for DuPont that ERISA plan administrators must make benefits determination and benefits disbursement decisions solely based on plan documents and valid participant assignment.

According to Dr. Jin Zhou, president of ERISAclaim.com, a national ERISA expert, and reimbursement compliance consultant, it is increasingly popular from industry existing practice that health care providers historically ignored these protections from federal law, ERISA, in failing to secure valid ERISA Legal Assignment for Benefits from their patients, therefore insurance companies and health plans will have no obligations to any health care providers in absence of valid ERISA assignments, in accordance with DOL claim guidelines, ERISA FAQ, B2. On the other hand, if with a valid ERISA assignment, and an insurance company or health plan must send reimbursement checks directly to healthcare providers as a designated and authorized representative, regardless of network partic
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