Health Insurance | ERISA
In the complex and fast changing world of health plans and health insurance, one thing remains the same: the vast majority of health plans and health insurance policies are sponsored by employers or groups, which makes them governed by ERISA, the Employee Retirement Security Income Act of 1974. This federal law — unknown to many — is a powerful set of laws and regulations that can be applied to obtain fair treatment and protection to medical providers and their patients. Medical providers need to be educated about this law and then must have proper counsel in order to take full advantage of the tools available here.
Our firm uses the ERISA Claims Regulation and the rights of the patients to oppose and defeat post payment audits, claw backs, and recoupment of funds previously paid by health insurers. We also use ERISA, the patients’ ERISA rights, and various State’s laws to collect sums due to medical providers on denied claims.
When a claim is received and handled by a health plan (self-insured) or a health insurer (group insurance policy), the process is governed by the federal ERISA Claims Regulations. And the relationships between patients, medical providers, health plans, and health insurers are all controlled by the ERISA law itself. A law firm representing medical providers must know how to use this law and its Claims Regulations to help medical providers in their contentious relationships with health plans and health insurers.
The next challenge is for doctors and other medical providers to have confidence that, yes, you indeed have leverage. And yes, the law can work for you — not against you. All you need is the right legal team on your side and the confidence to know that the team is uniquely qualified to resist an audit, fight off a recoupment / refund demand, stop claim offsetting, or help you get paid on claims.
Quadrino Law Group uses ERISA as one of the main tools in working to help medical providers across the country. Combining over 40 years of ERISA know-how with 90 years of insurance industry and claims experience is how QLG’s Health Insurance practice group achieves Results for clients.
So if claims are being delayed or denied, we can help. If you are at wits end and want or need to take it further, we are here for you — and you’ll learn how we can pursue a successful resolution.
Federal Appeals Court Rules that Express Scripts is an ERISA Claims Administrator That Must Follow the ERISA Statute and its Claims Regualtions
A U.S. Court of Appeals has ruled, in a case handled by Quadrino Law Group, that pharmacy benefits claims under group health plans are governed by the ERISA statute and the federal Claims Regulations issued under ERISA…
Federal Court Rules That Attempts to Reverse Prior Claim Decisions Through Post Payment Audits May Be Unlawful Under ERISA
Quadrino Law Group won a motion in federal court, with the judge stating that the insurer’s technique of reversing prior claim decisions and demanding repayment from the medical practice “may be unlawful pursuant to ERISA”…
ERISA Used As a Tool to Obtain The Release of $11 Million of Hijacked Funds By A Pharmacy Benefits Administrator
When a company that holds, funnels, and disburses funds to pharmacies began withholding millions of dollars from a pharmacy due to ongoing audits, we were hired to jump in and fight for a release of the hijacked funds…