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.
ERISA has a 40-year history in the courts as to how health plan claims should be handled and what the role of an insurer or health plan administrator should be…
Major Insurer Settles for “Walk-Away” in Case Challenging Claw Back of Claims Previously Paid to Medical Providers
A major health insurer notified several medical practices that it changed its mind on a series of claims that it previously paid for blood tests for various patients. The insurer alleged that the tests were experimental or investigational and that the medical...
When a health insurer began a campaign to recoup millions of dollars it paid on past claims from a variety of medical practices, Richard Quadrino put together…