Ever Wonder What You Can Do About That Patient’s (ERISA) Claim That Just Won’t Get Paid?

Did you know that the Employee Retirement Income Security Act (ERISA) governs nearly 2.5 million health benefit plans nationwide? In total, these plans provide health care benefits to 134 million Americans. The far-reaching nature of ERISA regulations is important because these regulations have very specific requirements aimed at ensuring fair treatment to the beneficiary. ERISA regulations require a timely response from the insurer, delineate standards of claims decisions, and require the insurer to disclose detailed information regarding any adverse determinations. It is important to familiarize yourself with these regulations so you can assist your patients in ensuring their health plan is following ERISA regulations, if applicable. ACA has updated and simplified the information available for members regarding ERISA. Please take time today to have your staff review this information and think about whether you have any patients that might qualify for and benefit from an ERISA appeal. This resource can be found at: