Insurance companies do not have the last word on whether they pay a healthcare claim. The federal government does, according to the Employee Retirement Income Security Act (ERISA) of 1974. Sadly, commercial insurers routinely violate this law.
ERISA is a federal law that protects hospitals and patients.
As hospitals struggled during the pandemic, commercial insurers saw revenue increase as much as 44% as they increased claim denials.¹
1. Change Healthcare white paper. “A Review of National Medical Claim Denial Trends.”
ERISA’s appeals process can force commercial insurers to pay.
This landmark legislation sets strict standards for transparency about employee pension and healthcare plans, which insurers must honor. But despite the law strengthening through amendments over time, most insurance company violations of ERISA go unappealed.
Denials increased 23% from 2016 to 2020, with the biggest increase falling, cruelly, on regions with the highest first-wave Covid-19 rates.²
2. Amanda Holpuch, The Guardian. “US health insurers report billions in first quarter as small providers face stress.” May 8, 2021.
The law protects you from retaliation.
Anti-retaliation rules strictly prohibit insurance companies from withholding benefits as punishment for you to exercise your rights under ERISA. When claim denials are properly appealed, federal law is on your side — even with claims aged up to 10 years.
When insurance companies underpay and deny legitimate claims, they are in violation of federal law. ERISA appeals hold them accountable.
But most hospitals aren’t equipped to apply this leverage.
This is a complex law spanning about 80,000 pages. Few hospitals, if any, have the knowledge to identify ERISA appeal opportunities or the resources to implement the appeals process.
ERISA claims appeals involving attorneys are eight times more expensive than using ERISA Recovery’s proprietary process.³
3. Bob Young. Press release for California Workers’ Compensation Institute. “CWCI Analysis Measures Attorney Involvement In California WC.” February 5, 2014.
ERISA Recovery can give you a brand new revenue stream.
Our proprietary ERISA appeals process collects where others can’t. Since 2011, we’ve been honing both our expertise in this appeals process and technology to help us wield it efficiently.
That’s how we win for hospitals and patients.
First, we analyze your reports
This requires no upfront cost, hospital resources, or vendor changes.
All we need are the reports your revenue cycle management team routinely generates. That’s it. Show us your aged, complex, most “uncollectible” claims, and we’ll do the rest.
Next, we identify opportunities
ERISA appeals can recover at least 1.5% of your claims denials.
We use advanced data mining technology, aided by artificial intelligence (AI), to quickly uncover patterns of contract-breaking underpayment.
Finally, we appeal — and you win
The average appeal size wins $1M in revenue in just 90 days.
We recover millions for each hospital system we work with. This translates into a brand new revenue source to help protect your bottom line and improve patient care.