ERISA AND OTHER PRIVATE MEDICAL LIENS
About ERISA and Other Private Medical Liens
Resolving ERISA and Other Private liens can be challenging for several reasons:
- Private health plans have a range of rights to reimbursement based on the type of private plan in question:
- ERISA (many employer plans) and other private plans’ rights are based on the language of their plan contract and or federal or state law, depending on the plan’s funding type.
- Each state’s insurance laws vary greatly regarding private health plan lien collection.
- These plans often have a strong right to reimbursement and may pursue that right aggressively.
These plans often enforce their right to reimbursement through a third-party subrogation Vendor, that collects and negotiates the liens on behalf of the health plan.
CP Resolutions Services for ERISA and Other Private Medical Liens
CP Resolutions has resolved a variety of ERISA and private liens – ranging from ERISA to Medicare Supplement. We have strong relationships with health plans as well as subrogation vendors, allowing up to keep careful track of the progress of obtaining lien information. We also have knowledge of the various reduction tactics available depending on the type of Private plan and which authority- state law, federal law, and or language of the plan’s contract- governs the plan’s right to reimbursement.
Frequently Asked Questions
- If ERISA or Private Plans are not being asserted by the Federal or State Government, why should I worry about addressing them?
- Private health insurance often retains a contractual or equitable right to reimbursement. Failing to address a lien from an ERISA or other private plan could put the claimant at risk of legal action and or discontinuation of their health coverage by the plan.
- Can ERISA and other private liens be challenged and reduced?
- Yes! ERISA and other private liens can be reviewed by our Nurse Expert to ensure that each charge is related to the injury in question, and CPR specialists will challenge unrelated charges as appropriate. Additionally, private liens are often subject to equitable principles calling for required reductions. If circumstances warrant, the specialist will also request a compromise to reduce the lien even further.
- How do I Know if my Claimant’s Insurance is ERISA or Private?
- Private health plans are any that are not: Medicare, Medicaid or Military/Indian Health Services