Court Ruled Against CIGNA & UHC UCR Class Actions by Out-of-Network Providers On Poor ERISA Assignment

Hanvor Park, IL (PRWEB) November 30, 2011

On Sep. 23, 2011, the federal District Court in New Jersey dismissed all out-of-network provider plaintiffs UCR class action claims against CIGNA and UnitedHealthcare solely based on the poor and limited ERISA Assignment of Benefits. Franco v. Connecticut General Life Ins. Co. (Case 2:07-cv-06039-SRC–PS) was filed in federal court, District of New Jersey, as one of the largest UCR class actions after the UnitedHealthcare UCR settlement, by several patients, numerous out-of-network providers, several provider State Associations and the American Medical Association (AMA), alleging violations of the ERISA for wrongful UCR denials and reimbursement. ERISAclaim.com offers new webinars to examine the profound impact of this federal court ruling on ERISA requirements for Assignment of Benefits, and to discuss on how to secure valid ERISA and PPACA Assignment of Benefits, in order to prevail on all provider appeals and judicial reviews.

“This court ruling underscores the importance of the urgent providers’ compliance with ERISA and PPACA requirements of Assignments of Benefits. Now the Court has found that all of provider’s traditional, decade old Assignments of Benefits without ERISA compliance are legally useless for reimbursement, appeals and lawsuits, we must change now to comply with ERISA," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

Usual, Customary and Reasonable (UCR) denials are the most commonly seen partial claim denials for all out-of-network providers and hospitals in USA.

According to the court documents, the federal Court finds that all provider plaintiffs have failed to provide the court with complete ERISA Assignment of Benefits as a matter of law in provider plaintiff complaints. All the providers, State Associations and AMA have provided in court are only limited Assignment of Benefits. After finding that there isn't any valid or complete ERISA Assignment of the Benefits by all providers, the Court dismissed all UCR ERISA claims asserted by all provider plaintiffs, State Associations and AMA.

In particular, among other things, the Court concluded the following:

“At best, the allegations provide only the most ambiguous and conclusory information about what the purported assignments entail. At worst for Provider Plaintiffs, they indicate that the assignments were limited to a patient’s assigning his or her right to receive reimbursement from CIGNA for the covered portion of the service bill, which in no way can be construed as tantamount to assigning the right enforce his or her rights under the plan. The Court cannot conclude, based on the information supplied in the Complaints, that the assignments encompass a CIGNA-insured’s claim to benefits, such that any of the Provider Plaintiffs can legally be deemed a “participant or beneficiary” of his or her patient’s ERISA health plan. Simply put, Provider Plaintiffs have not met their burden of demonstrating that they have derivative standing to sue under ERISA.

All ERISA claims asserted by Provider Plaintiffs in the CAC and North Peninsula Complaint will accordingly be dismissed.” (Case 2:07-cv-06039-SRC -PS Document 638 Filed 09/23/11 Page 20 of 82 PageID: 25499)

A copy of complete court decision is available at: http://ERISAclaim.com/Franco_v_CIGNA.pdf

The new ERISAclaim.com webinars will discuss in detail of this Court order and explain why providers nationwide have failed in ERISA compliance for valid Assignment of Benefits as the most important first step in claim reimbursement and appeals, ultimately lawsuits in federal court.

The webinar will cover the following topics:

1.    The court factual and legal analysis and conclusion of provider traditional, decade old Assignment of Benefits, for the one of the largest out-of-network provider UCR class action lawsuits against CIGNA and UnitedHealthcare: the court decision from page 11 to page 20.
2.    The court concluded that the decade old, industry traditional provider assignment of benefits are only limited assignment under ERISA and legally useless, but a complete ERISA assignment of benefits is required for all ERISA appeals and lawsuits by third-party providers.
3.    What exactly does an ERISA complete Assignment of Benefits mean?
4.    How to secure a valid and complete ERISA compliant Assignment of Benefits?
5.    Why is ERISA Assignment of Benefits Form required for both in and out of network providers?

On March 23, 2010, President Obama signed into law the Health Reform Bill, PPACA (Patient Protection and Affordable Care Act). PPACA claims and appeals regulations went into effect on September 23, 2010. PPACA adopts ERISA claim regulation in its entirety, for group health plans and health insurance coverage in the group and individual markets, for almost all non-Medicare and/or non-Medicaid claims.
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056

Complete PPACA Regulations and Guidance can be found on DOL website:
http://www.dol.gov/ebsa/healthreform/

To find out more about the Total PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/Press_Releases.htm

Located in a Chicago suburb in Illinois, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

###

Read the full story at http://www.prweb.com/releases/2011/11/prweb9005769.htm