BCBS Ordered to Permanently Reform Its Overpayment Policies in Provider Class Action – ERISAclaim.com Demystifies
PR Web |
On
Case Info:
ERISAclaim.com provided the plaintiff providers with ERISA appeal compliance and ERISA litigation support in this provider ERISA class action.
In this landmark decision against a BCBS entity,
"This permanent injunction from the federal class action court establishes the first and complete set of case laws for the overpayment recoupment and offsetting denials, the No. 1 health claim denials in USA", says Dr.
"This permanent injunction is a huge victory not only for PCA members but also for every patient and provider in USA. The court finally provides all health plans with full ERISA guidelines as intended by
According to court documents, in addition to the permanent injunction for IBC to fully comply with ERISA EOB and full and fair review regulations: "IT IS HEREBY ORDERED THAT defendant
"AND IT IS FURTHER ORDERED THAT Defendant IBC is permanently restrained and enjoined from issuing or pursuing any demand for repayment of benefits previously paid to a PCA member, including offsetting any new claims based on an alleged overpayment, unless IBC complies with the procedures outlined above," according to court document.
"AND IT IS FURTHER ORDERED THAT after the procedures are applied with regard to disputes raised by a PCA member concerning a repayment demand, any determination reached by IBC that upholds any portion of the repayment demand to the PCA member will constitute a new adverse benefit determination under ERISA for purposes of statutory or contractual limitations periods." according to court document.
"More importantly, ObamaCare, PPACA, adopted ERISA claim regulation in its entire for all health plans", says Dr. Zhou.
"(i) Minimum internal claims and appeals standards. A group health plan and a health insurance issuer offering group health insurance coverage must comply with all the requirements applicable to group health plans under 29 CFR 2560.503–1 …. with respect to health insurance coverage offered in connection with a group health plan, the group health insurance issuer is subject to the requirements in 29 CFR 2560.503–1 to the same extent as the group health plan." according to PPACA regulations for Internal Claims and Appeals and External Review. http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056
ERISAclaim.com offers new basic and comprehensive ERISA and PPACA overpayment appeals and litigation support programs, for all hospitals, providers and healthcare attorneys.
To find out more about ERISA & PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
Located in a
For any questions, please contact Dr.
Read the full story at http://www.prweb.com/releases/2014/05/prweb11868183.htm
Copyright: | (c) 2014 PRWEB.COM Newswire |
Wordcount: | 810 |
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News