QUESTION:
Will the new Health Care Reform Law have any affect on ERISA plans and subrogation in the future? – FL Attorney
ANSWER: Right now there are many unknown variables regarding ERISA plans and the new Patient Protection and Affordable Care Act of 2010 that was signed into law on March 23, 2010. What we do know is that health insurance practices, including Subrogation and Recovery will experience changes over the next few years. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans (US Department of Labor, www.dol.gov). Employer provided health plans are governed by ERISA, which also loosely defines their right of recovery, allowing for “appropriate equitable relief” (29 USC 1132(a)(3)). Plans that are self funded by the employer are evaluated based on federal ERISA law for validity. However, it is reported that over the coming months, the Department of Health and Human Services will be conducting a study to evaluate the financial solvency and ability by self funded companies to provide consistent benefits during times of economic downturn, along with several other markers (www.myhealthguide.com). This may mean a change in the classification of employer provided plans from self – funded (under federal law) to insured plans, which are evaluated against state insurance law. Next year, in 2011, insurance plans will be required to provide specific plan descriptions (SPD) and coverage information in plain, easy to understand language with, definitions, and common sense examples in a uniform format (www.myhealthguide.com). This will allow for a clearer understanding of the subrogation rights and parameters in plain terms for evaluation per Sereboff v. Mid Atlantic Medical Services, Inc. (2006), where the plan’s recovery is defined by the specific language within the plan. It will be more important than ever to obtain a copy of the specific plan description for the year of coverage to which the claimant was injured. Paying attention to these detais may make all the difference in your settlement, and may save money for your client.
As more information about the changes to ERISA Lien Resolution and Subrogation are released, we will continue to assist in the understanding of the new measures. Lien Settlement Solutions offers ERISA, Private Insurance, and Hospital/Provider Lien Resolution Services. Contact us at (877)907-5436 or email at info@lienss.com for more information.
The Reviews Are In! Synergy’s Lien Resolution unit opened its doors in June 2009, with the purpose of providing complete lien resolution services to the trial bar. We make a special effort to be an advocate for our clients, and achieve the best possible results on their behalf. Well, now our clients have spoken! Here are a few testimonials! “I have been working with Synergy for the past nine months. I am very satisfied with the results [they have] accomplished for our firm on several of our cases.” Rosario Ingles, Closing Case Manager – Law Offices of William Ruggiero “Synergy was extremely knowledgeable and effective in assisting to reduce our client’s insurance lien. The staff was a pleasure to work with, extremely professional, and went above and beyond the scope of our expectations. Many times, throughout our case, [they] worked after business hours to accommodate our needs. The end result was a huge savings for our client and we hope to utilize her and the company in the future.” Joni Hautamaki – Didier Law Firm Call us today to see how we can assist in your case management! (877)907-LIEN (5436).
Important Information for Resolving Liens in Asbestos Cases. Asbestos Exposure cases are unique when it comes to lien resolution because of factors that are unlike any other type of litigation. Unlike a pharmaceutical case where the illness develops within a 1-3 year period, most asbestos-related diseases are diagnosed decades after the initial exposure. By the time Mesothelioma or Asbestosis are detected, the claimant is usually a retiree. In managing an Asbestos caseload, it is important to know what the lien obligations are, especially when dealing with multiple defendants. Origin of exposure, military service, dates of exposure, and whether the exposure is from a primary or secondary source are all important factors that impact the resolution of health insurance liens. 
Due to the 15 – 40 year latency period for the development of Mesothelioma, and 10 – 20 year latency period for Asbestosis, most asbestos claimants are over the age of 65. Many claimants receive Medicare, Medicaid, and VA health care benefits. It is important to know the recovery rights of these insurers before going forward with your case. (more…)
Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with. Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):
![DenialsByInsurer2008[2]](http://www.liensettlementsolutions.com/lienresolution/wp-content/uploads/2009/10/DenialsByInsurer20082.jpg "DenialsByInsurer2008[2]")
Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare. 33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers. Some of the common billing errors that providers make are: (more…)
Question: I have a case where the hospital has a claim that needs to be submitted to Medicaid for payment. However, since the hospital knows that there is a liable third party, they are refusing to submit the claim to Medicaid. How can I force the hospital billing office to submit the claim for payment? – FL Attorney
Answer: In this instance, the provider has the right to go either way, so there is no real avenue to “force” a provider to bill Medicaid for services. Under Medicaid’s provider agreement, the hospital has the right to bill all other insurers first, with Medicaid being the final payer. On the other hand, Medicaid has the right to subrogate for payments made when a third party is responsible.
Medicaid as Final Payer – Why the Provider can bill liable insurer: FL Statute 409.907(3)(f) – Medicaid Provider Agreement (3) The provider agreement developed by the agency, in addition to the requirements specified in subsections (1) and (2), shall require the provider to: (more…)
Quick tips that can move your settlement to the Head of the Class!
A – Allocation: When in the process of negotiating a settlement and determining the allocation of proceeds, be mindful of any outstanding lien obligations. Some plans may have a right to recover from the full value of the settlement if an allocation does not protect their interest.
B – Bargaining with a provider or recovery agent can be worthwhile if there is a clear understanding of the strength or weakness of their right of recovery. Make them an offer they can’t refuse!
C – Call! Regular communication is necessary, especially when resolving with Medicare, Mediaid or the Military Health Plans. Remember, the squeaky wheel gets the oil!
D – Delegate: When the task of Lien Resolution becomes to overwhelming, delegate this aspect of case management to the PROs! Lien Settlement Solutions offers programs that meet all of your lien resolution needs. Call us at (877)907- LIEN to speak to one of our representatives! (more…)
Dear Synergy;
I’ve got a settlement and an 18 y/o client whose mother works for the federal government. All the medical bills appear to have been paid by the mother’s private insurance company, but I suppose that they may be the administrator. This is an Anti Subrogation state, but we assume that FEHBA plans are preempted. We have received no notice from the FEHBA or Private Insurer plans about any sort of subrogation interest. Have you been down this road before? – Confused in the Carolinas
In reviewing FEHBA subrogation, it generally preempts state law and is not beholden to ERISA law in which North Carolina is an Anti Subrogation state for some insured plans. I’ve been looking for any type of loophole where NC’s anti subrogation can be can be argued for a FEHB plan, but everything I’ve found is to the contrary. The strength of the right of recovery in a FEHBA plan lies in the specific description within the plan. I looked through a few plans to get an idea on how NC FEHBA plans are written. Specifically, I reviewed the BCBS of NC FEHBA Standard and Basic Operation plan for 2009 to get an idea of what the plan language may look like in this situation. According to the 2009 plan, it is the responsibility of the beneficiary to notify BCBS of any claim made against another party for compensation of an illness or injury where BCBS has made payment. According to their plan language, they are entitled to full recovery, and not subject to reduction for procurement. However it does express a willingness to grant a reduction at their discretion. It was not specified if the incident occurred in 2009, you would need to review the plan document for that year of enrollment. Hope this helps! Have a lien question? Ask us! Send your question to info@synergysettlements.com.