American Bar Association American Bar Association

Group Health Claims and Appeals: The Brave New World for Making, Administering and Paying Health Claims

SPONSORS: The Sections of Business Law; Health Law; Labor and Employment Law; Real Property, Trust and Estate Law; Taxation; Tort Trial and Insurance Practice; and the American College of Employee Benefits Counsel

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Untitled Document

A 90-minute TeleConference
TUESDAY, JUNE 14, 2011

1:00-2:30 pm ET / 12:00-1:30 pm CT / 11:00 am-12:30 pm MT / 10:00 am-11:30 am PT

Elizabeth Leight
, Society of Professional Benefit Administrators, Chevy Chase, MD

Cynthia Marcotte Stamer, Cynthia Marcotte Stamer, PC, Addison, TX
Bernard V. Kearse III, Bernard V. Kearse III PC, Atlanta, GA
Jahnisa P. Tate, Alston & Bird LLP, Atlanta, GA

New federal claims and appeals requirements enacted as part of the health care reforms of the Patient Protection and Affordable Care Act (ACA) are only one of several legal developments changing the legal landscape for the administration and enforcement of ERISA-covered health plan claims and appeals. Always challenging, legislative and regulatory reforms, Supreme Court and other emerging precedents, evolving products and practices and heightened sophistication of parties are driving the intricacy of health claims and appeals administration and litigation to new heights. Health and disability plan insurers, administrators, fiduciaries and sponsors, independent review organizations and other payer service providers, health care providers, participants and beneficiaries and the attorneys counseling and representing them need a strong understanding of the evolving claims and appeals requirements and their operation. Our experienced panel of experts will help participants update their understanding and skills for dealing with these evolving and increasingly complex rules governing ERISA-covered health claims and appeals by providing:

  • Up-to-date roadmap of current federal mandates impacting health-claims and appeals administration under ERISA as amended by the Affordable Care Act;
  • Update on the latest Department of Labor guidance governing ERISA health claims and appeals administration as implemented by its 2000 Claims Regulations;
  • Update on the latest guidance on the New Affordable Care Act-mandated internal and external review and other claims and appeals requirements for non-grandfathered health plans;
  • Update on emerging judicial precedent on ERISA preemption, standards of review, and other key issues impacting health claims related litigation in the federal courts;
  • An examination of the interplay between ERISA, ACA, state Prompt Pay and other state insurance claims and appeals regulations in the administration and enforcement of ERISA claims and appeals decision;
  • Practical operational and litigation tips and insights.

Group Health Claims & Appeals: The Brave New World for Making, Administering, & Paying Health Claims
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