Managed Care Advisor (Contracting & Reimbursement), a national publication for medical professionals, ran a feature story about our partner’s use of ERISA as a little-known leverage point that medical providers have in the world of insurance reimbursement. Our partner was featured in the front page piece, detailing his views on the applicability of ERISA to group health insurance claims and the many issues that medical providers need to be aware of.
Our partner explained how the timing requirements under ERISA must be strictly adhered to by health insurers and that there are legal consequences when a health insurer violates the ERISA regulations. The regulations govern not only the timing of an insurer’s response to a health insurance claim, but the manner and content of the insurer’s response. Faulty responses by health insurers may even excuse a medical provider from the need to file an ERISA appeal of the claim denial. The article reveals certain indispensable principles that can increase the leverage — and thus the income — of medical providers in the payment / reimbursement realm.
Medical providers should be sure to contact attorneys with the special knowledge in this field in order to both maximize profits and avoid insurer audits that seek refunds. Please feel free to contact us at 800 745 1755 for more information.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com