The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com
The New Healthcare Reform Bill Passed by The Congress Prompted The New Claim Specialist Certification Class from ERISAclaim.com
Hanover Park, IL (PRWEB) November 9, 2009
ERISAclaim.com announced the first Claim Specialist Certification class under new healthcare reform legislation, the Affordable Health Care for America Act, after the House of Representatives passed a sweeping health care bill, H.R. 3962, Saturday night (November 7, 2009) with a tight vote of 220-215, making it the biggest expansion of health care coverage since Medicare was created more than 40 years ago for 96% of Americans.
President Obama said he was “absolutely confident” the Senate will follow suit in passing its version of the bill. “I look forward to signing comprehensive health insurance reform into law by the end of the year,” he said.
Although turning the bill into law remains uncertain for many provisions from different Senate Partisan Bills, it is absolutely certain that claims regulation for reimbursement under this new federal law is clear and well settled from the bipartisan Bills and as many as 14 provisions of this new federal legislation will go immediately into effect when signed by the President Obama at the end of the year. It is critically important and urgent for healthcare providers to be educated and trained to be the first certified claim specialists under this most comprehensive and new federal healthcare reimbursement law. We are also offering free webinar to explain the new legislative impact for healthcare providers and everyone under the Act.
Although it is uncertain what will be signed into law as to the antitrust provision of H. R. 3962 and whether the government or insurance companies will collect and manage the mandatory insurance premiums, it is absolutely clear that a new federal claim regulation will be signed into law, as passed by the House of Representatives. ERISA claim regulation, 29 CFR 2560.503-1, will be statutorily incorporated in its entirety into the new law for all qualified health benefit plans (QHBP), as the most important provisions from H. R. 3962 for healthcare providers for reimbursement purposes. The Affordable Health Care for America Act will create a new federal agency, Health Choices Administration, regulating qualified health benefit plans (QHBP), consisting of employment-based health plans, the traditional voluntary ERISA plans, and health insurance exchange plan, the new mandatory ERISA plans. The new legislation, H.R. 3962, is significant with following provisions:
1. Sec. 232 (b) of the Act, Requiring Fair Grievance and Appeals Mechanisms of the Act provides: “(b) INTERNAL CLAIMS AND APPEALS PROCESS.–Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503-1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish”.
2. Sec. 232 (c) of the Act also creates a new federal external review process based on ERISA claim regulation to provide for an impartial, independent, and de novo review of denied claims, and the Health Choices Commissioner’s decision shall be binding on the plan and the entity, as the final claim decision in absence of judicial reviews, which is available now for punitive damages for exchange participating health plans.
3. Sec. 233 of the Act, Requiring Information Transparency and Plan Disclosure, enhanced the existing ERISA disclosure obligations for the plan and insurance company, and requires “Accurate and Timely Disclosure”, for both exchange participating health benefit plans and employment-based health plans, to both Health Choices Commissioner and the public, doctors, hospitals and the patients, of plan documents, plan terms and conditions, claims payment policies, and practices, periodic financial disclosure, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information.
4. Sec. 233 (5) of the Act, Cost-Sharing Transparency, requires the plan to disclose to the healthcare provider the real fee schedule, plan UCR limit for individual service and supplies at CPT & HCPCS code level.
5. Sec. 235 of the Act, Timely Payment of Claims, provides new federal “Prompt Pay” laws, based on Medicare Part C timeframe, Managed-Care Medicare, to comply with the requirements of section 1857(f) of the Social Security Act.
6. Sec. 238 of the Act, State Prohibitions on Discrimination against Health Care Providers, has adopted “Any Willing Provider Laws” from existing state laws.
7. Sec. 251 of the Act provides new consumer protections, or Obama Patient Bill Of Rights, with state law compensatory and punitive damages as remedies for exchange-participating health plan members, although the new law does not change ERISA preemption of state punitive damage remedies (License to Kill, as some referred to) for employment-based health plans (traditional ERISA plans).
8. Sec. 257 of the Act allows state attorney general to sue for the compensatory and punitive damages on behalf of the private citizen of the state for any violations by the exchange-participating health plans, although traditional ERISA plan is still immune from state government actions from insurance Commissioner or attorney general.
9. Sec. 262 of the Act, Restoring Application of Antitrust Laws to Health Sector Insurers, if signed into law, this will officially provide statutory death penalty for managed care practice model in USA, in conjunction with vigorous enforcement of new federal ERISA claim regulation, complete disclosure of plan information and fee schedules.
The Affordable Health Care for America Act is 1990 page long. For more information and relevant documents, please visit the Website of House Of Representatives:
http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687&catid=156&Itemid=55
ERISAclaim.com, located in northwestern suburb of Chicago, Illinois, is an online publisher, consultant and educator for ERISA claim education, training and consulting as well as claims recovery for ERISA healthcare claims. It also provides ERISA litigation support, research assistance and fraud and abuse prevention as well as PPO auditing defense consulting. In addition to ERISA, ERISAclaim.com also provides consulting and education for Medicare Claim Appeals Specialist, for Medicare RAC overpayment appeals, fraud and abuse prevention.
Dr. Jin Zhou, the president of ERISAclaim.com, developed the nation’s first ERISA education and practical appeal system for healthcare providers 10 years ago, He has gained most comprehensive and unique practical experience in training and consulting in ERISA claims for healthcare providers for more than 10 years. Dr. Jin Zhou was sometimes referred to as the “Godfather of ERISA Claims” for healthcare providers by some industry experts.
For more information or to arrange an interview, please visit http://www.erisaclaim.com/certification.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.
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Categories: Social security act Tags: Bill, Certification, Claim, Class, Congress, ERISAclaim.com, from, Healthcare, Passed, Prompted, Reform, Specialist
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An Open Letter To President Obama on Health Care Reform and What It Means To My Family
An Open Letter To President Obama on Health Care Reform and What It Means To My Family
Mr. President:
I know that you are a very busy man so I will try to keep my questions about health care reform and the recently passed legislation as short and simple as possible.
- I could ask you why you think this is a good piece of legislation even though I truly believe that it will be a failure and will come very close to bankrupting the country. The basis for my conclusion has nothing to do with political partisanship (in fact, I have never voted for a Republican for national office in my life.) From my perspective, “Obama Care” never effectively addressed the root causes of our escalating health care costs: Americans eat too much of the wrong kinds of food, they exercise far too little, they are overweight, they smoke too much, and they are getting older. This legislation does not address these causes, it just raises taxes and moves money around within the bureaucracy. I could ask you about this but I will not.
- I could ask you why you have not stepped forward and denounced those in your party that have likened Americans like myself, i.e. those that have legitimate and honest concerns about this health care reform bill, to the racists who fought against the civil rights movement from the 1960s. I thought that we lived in a free country where citizens could freely address their elected representatives without being slurred in the most debasing way possible, just for having a different opinion. Your lack of fortitude to oppose those Democrats who frequently use the term “racist” to malign myself and those Americans expressing their honest opposition, cheapens the bravery and contributions of those from long ago that fought actual racism. I could ask you about this but I will not.
- I could ask you why you felt it necessary to pass this legislation by the back door called reconciliation. This is a major, major issue in the country that will affect every American for decades to come. Sneaking it in the back door, without using the traditional, time honored method of passing laws in his country, belittles the approach and makes it look like it was forced through without the full weight of the democratic process behind it. I could ask you about this but I will not.
Here is what I will ask you about. But first, some background facts:
- Let me reiterate that both my wife and myself have never voted for a Republican for national office in our lives.
- We both spent several decades of our lives working hard for AT&T, retiring several years ago, secure in our thinking that AT&T’s promise of health care benefits and coverage for our long years of service was a good bet.
- We both try to eat well, we exercise at our local YMCA on an almost daily basis, neither of us smoke, and we rarely drink. In other words, we take personal responsibility for our health and our health care.
One reason for our personal responsibility behavior is that we are on a high deductible insurance plan with AT&T. We are each responsible for the first ,200 of our annual health care costs before we get any insurance coverage at all. However, for this personal responsibility, we also pay nothing in annual premiums.
- During the debate leading up to the passage of health care reform, you reiterated more than once that those of us that currently had health care coverage would be able to keep it. However, in a recent article in Fortune magazine, the CEO of AT&T, Randall Stephenson, was interviewed (several pages of the article are attached). Towards the end of the interview, he was explicitly asked whether AT&T would consider dropping health care insurance coverage for its employees and retirees. His response made it clear that this was a very viable option for two reasons. First, from a business profitability perspective, under the new health care reform law, “you’re better off paying the government a fine and dropping health care coverage for your employees”, improving AT&Ts bottom line. Second, he talks about “economic gravity” which appears to be code words for “if others in his industry do it, AT&T will have no choice but to do it also.”
Thus, a few quick questions for you:
1) Were you just naive when you made the comments that we could all keep our current health care insurance, not realizing the simple fact that companies are in business to make money and if this bill makes it easier for them to make more money by not insuring their workforce, that is what they will do? Or were you being disingenuous, knowing that this would happen and deliberately misinforming the country to help get your health care reform bill passed? Naive or disingenuous, in either case you will be making millions of American voters unhappy in November and in 2012 when we are forced out of our current health care coverage and will blame you for either ignorance or arrogance in this situation.
2) I am 57 years old and my wife is 56 years old and if Mr. Stephenson does decide to terminate AT&T’s health care coverage for employees and retirees, where do you suggest that my wife and I get coverage? What insurance company is going to want to pick us up, and millions of other older Americans who lost their coverage, at our ages even though we are both healthy and taking personal responsibility for our continued good health?
3) If we are forced out onto the market for health care insurance coverage, our new coverage is likely going to be much more expensive. Our annual health care costs will go from a maximum of ,200 each to a minimum of several thousand dollars each. Is this how you planned to reduce health care costs for middle class America? Is so, then you need to explain the math to me. Maximum of ,200 to a minimum of several thousand dollars, does not make sense out here in the real world. How does this reduce the escalating health care costs for the 90% of Americans that already had health care insurance prior to the passage of this bill?
Thus, I am not going to ask you about why you and the rest of Congress did not address the root causes of high health care costs in your legislating process. I am not going to ask why you have sat back and been silent while those Americans with legitimate and honest dissent against this bill have been likened to racists by members of your party. I thought you represented all Americans, not just those that agreed with your policies. I will not ask you about why you did not have the courage and guts to pass this legislation the right way, through the front door like every other piece of legislation, but instead snuck it through the back door of reconciliation.
However, I will ask you or your staff to contact me and explain where and how I can get health care coverage at my age if AT&T and the rest of corporate America decides it is a better economic choice to pay a government fine than to cover their employees and retirees with health insurance. I will ask you to explain whether you were naive or disingenuous when explaining that we would be able to keep our current health insurance coverage. And finally, please explain how paying no more than ,200 a year under my current coverage (with many years paying nothing for coverage during healthy years) is a better deal then finding new coverage at my age and paying several thousand dollars a year for the privilege.
Although I have written to the White House many times, I have never received any answer to my questions on a wide variety of topics even though you promised to have the most open and responsive administration of all time. That has not happened yet. However, in this case I do require, in fact I demand specific answers to my three questions above. For your political sake I hope to receive those answers before early November and certainly before 2012.
Thank you for your time,
Walter “Bruno” Korschek
[Follow up note: a month after sending this to the White House, no answers to the questions have been received or even a simple confirmation that this letter was received has been forthcoming from the Obama adminstration.]
Walter “Bruno” Korschek is the author of the book, “Love My Country, Loathe My Government – Fifty First Steps To Restoring our Freedom and Destroying The American Political CLass,” which is available at www.loathemygovernment.com and online at Amazon and Barnes & Noble. You can join our daily dialog on freedom in America at www.loathemygovernment.blogspot.com.
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