Get Familiar With Erisa And Avoid Missed Appeal Opportunities

By Author: Erin Article
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Don't lose money because you are ERISA-ignorant

More than 80 percent of non-Medicare claims fall under ERISA regulations. Therefore, you are costing your practice a lot of money in missed appeal opportunities if you are unaware of the basics of Employee Retirement Income Security Act (ERISA) claims. With more than, you stand to lose a lot by not knowing your stuff. Set yourself on the path to proper appeals with following expert answers to your top ERISA questions

1. About ERISA

ERISA is a federal law, enacted in 1974, governing insurance plans that are self-funded or paid for by an employer, including group plans, PPOs and HMOs. Remember, ERISA does not include Medicare or Medicaid carriers.

ERISA was originally designed to protect an employee's retirement benefits. As employers were starting to provide healthcare as a benefit of employment, your healthcare benefits were added to the ERISA law.

When filing an appeal, remember that ERISA is a federal law and, according to Title 29, United States Code, Chapter 18, Section 1144 (a), ERISA supercedes ...
... any state regulations.

2. Which Insurance Plans Covered by ERISA Cover

Any employee benefit plan is included under ERISA law and there is no segregation by HMO, PPO, POS, IPA, etc. In fact, 82 percent of non-Medicare and non-Medicaid claims filed by physician offices are subject to ERISA

Here are the exceptions to ERISA:

Medicare,
Medicaid
Tricare
any state, county, and city government employees.
Church plans -- including those working for businesses owned by the church
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