“However, Petitioner’s argument that physicians and patients could have and should have appealed plan’s denial decisions is not completely pointless, had ERISA plans and managed care industry in past 30 years followed ERISA claim procedures, established and maintained reasonable ERISA appeal procedures for physicians and patients.
No one in the country for 30 years knows how to do ERISA appeals, almost all physician’s ERISA appeals were dismissed by courts on the ground of ERISA plan’s anti-assignment provisions when petitioner argues that:
Reply brief for Aetna Health Inc. (Page 6):
“If physicians disagree with denials of coverage, they may provide the recommended care or services and pursue the ERISA beneficiaries’ rights to payment themselves, pursuant to the assignment of benefits taken at the outset of providing care. See, e.g., Decatur Mem’l Hosp. v. Conn. Gen. Life Ins. Co., 990 F.2d 925, 926-27 (7th Cir. 1993).”
and ERISA appeals were done for patients in the following fashion:
Aetna Video Shows ERISA Patients Mistreated
McDougall vs Pelchart, et al (Aetna, UPS)
And the leadership foreclosed meaningful ERISA appeals through ERISA adminstrative enforcement to avoid tort actions by patients:
[rules to be “self-enforcing”] & Leadership.
Employers and ERISA managed care industry must practically and meaningfully promote ERISA claim appeal educations, compliance and enforcement to use meaningful ERISA administrative appeal avenue to avoid Tort avenue to solve this conflict and the root of U.S. healthcare crisis with skyrocketing costs.
Had Davila and Dr. Lopez afforded meaningful ERISA Appeals by ERISA plans, this whole tort thing would never have happened.
ERISAclaim.com – Supreme Court Managed Care ERISA Watch
http://erisaclaim.com/Suprem_Court.htm
“However, Petitioner’s argument that physicians and patients could have and should have appealed plan’s denial decisions is not completely pointless, had ERISA plans and managed care industry in past 30 years followed ERISA claim procedures, established and maintained reasonable ERISA appeal procedures for physicians and patients.
No one in the country for 30 years knows how to do ERISA appeals, almost all physician’s ERISA appeals were dismissed by courts on the ground of ERISA plan’s anti-assignment provisions when petitioner argues that:
Reply brief for Aetna Health Inc. (Page 6):
“If physicians disagree with denials of coverage, they may provide the recommended care or services and pursue the ERISA beneficiaries’ rights to payment themselves, pursuant to the assignment of benefits taken at the outset of providing care. See, e.g., Decatur Mem’l Hosp. v. Conn. Gen. Life Ins. Co., 990 F.2d 925, 926-27 (7th Cir. 1993).”
and ERISA appeals were done for patients in the following fashion:
Aetna Video Shows ERISA Patients Mistreated
McDougall vs Pelchart, et al (Aetna, UPS)
And the leadership foreclosed meaningful ERISA appeals through ERISA adminstrative enforcement to avoid tort actions by patients:
[rules to be “self-enforcing”] & Leadership.
Employers and ERISA managed care industry must practically and meaningfully promote ERISA claim appeal educations, compliance and enforcement to use meaningful ERISA administrative appeal avenue to avoid Tort avenue to solve this conflict and the root of U.S. healthcare crisis with skyrocketing costs.
Had Davila and Dr. Lopez afforded meaningful ERISA Appeals by ERISA plans, this whole tort thing would never have happened.
ERISA Failure = Tort Actions = Healthcare Crisis”
http://erisaclaim.com/Suprem_Court.htm