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- Nassau County Police Department (NCPD) Foundation Funds NCPD Police Youth Academy for Police Athletic League Special Needs Program
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- Federal Appeals Court Sides with Out-of-Network Providers and Patients – ERISAclaim.com Demystifies
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Nassau County Police Department (NCPD) Foundation Funds NCPD Police Youth Academy for Police Athletic League Special Needs Program
Garden City, New York (PRWEB) November 15, 2014
The Nassau County Police Department (NCPD) Foundation is funding a NCPD Police Youth Academy for 29 special needs students from the Police Athletic League program Saturday, November 15 at the NCPD Police Academy in Massapequa Park.
The Police Youth Academy, which was started in 2007, brings students from Nassau County School Districts to the Police Academy for a one-day modified academy. The Police Youth Academy exposes students to everyday police work and aims to establish a positive relationship between the Police Department and young adults.
Thanks to the support of the Nassau County Police Department Foundation, we will host an exciting day for special needs students involved in the Police Athletic League, said Nassau County Executive Edward P. Mangano. This program is important step in building a trust between children and the police.
The Police Youth Academy which runs from 9am 5pm consists of obstacle courses exercises demonstrating defensive tactics, police demonstrations and presentations by various department units including aviation, K9 and mounted.
The Police Youth Academy program is extremely important for children in our community, said Eric Blumencranz, Chairman of the NCPD Foundation. We are happy to partner with the Police Athletic League to support their special needs program and provide a great day for these children.
Each Police Youth Academy costs approximately $ 5,000 and through a grant from the NCPD Foundation last year of $ 20,000 this special police youth academy in conjunction with the Police Athletic League was able to occur.
DALLAS (PRWEB) November 11, 2014
SRS Real Estate Partners (SRS) announces highlights of October transactions and new assignments.
The SRS Real Estate Partners Birmingham office has announced several transactions.
Hanover Park, IL (PRWEB) November 06, 2014
On Nov. 5, 2014, federal Court of Appeals for the Ninth Circuit in California ruled for the plaintiff out-of-network providers ERISA right to sue United Healthcare on behalf of patients for out-of-network deductible waiver claim denials, because Defendants point out that Spinedex has not sought payment from its patients for claims, or portions thereof, that United and the Plans have refused to pay. ERISAclaim.com demystifies this court decision for all out-of-network patients and providers, with increasing number of the out-of-network deductible waiver claim denials.
On November 6, 2014, ERISAclaim.com announced new ERISA out-of-network claims specialist special training programs in accordance with this federal appellate court decision: It also included a statement in which patients acknowledged that they were liable for all costs of the services rendered.But the patients injury in fact after the assignment is irrelevant. As assignee, Spinedex took from its assignors what they had at the time of the assignment. At the time of the assignment, Plan beneficiaries had the legal right to seek payment directly from the Plans for charges by non-network health care providers. according to court document.
Case Info: Spinedex Physical Therapy USA, et al v. United Healthcare of Arizona, et al, Case No. 12-17604, in the United States Court of Appeals for the Ninth Circuit, filed on Nov. 5, 2014.
Regardless of upfront deductible or co-pay collection after the assignment, an out-of-network provider has ERISA right to sue for payment from an ERISA health plan, if with a valid patient ERISA assignment and patient legal obligation to pay the provider, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA appeals and compliance. Deductible waiver denial has been the No. 1 out-of-network claim denial, with [an] increasing number of out-of-network patient bankruptcies as a result of the national epidemic disastrous three-invoice patient collections.
This historical out-of-network case is a classic example of the most popular out-of-network claim denials today in America: the health plan will usually deny all out-of-network claims for alleged out-of-network deductible and coinsurance waivers by a provider, and allegedly the patient has not suffered injury in fact, then the health plan is not liable for any payment to the provider, explains Dr. Zhou.
In Spinedex, United Healthcare denied all out-of-network claims:
Defendants argue that because Spinedex has not sought payment from its assigning patients for any shortfall, those patients do not have the injury in fact necessary for Article III standing. Defendants argue that since Spinedex stands in the shoes of, and can have no greater injury than, its assignors, Spinedex has not suffered injury in fact, according to court documents.
The court rejected the Defendant United argument, and explained that an out-of-network provider has ERISA rights for payment and to sue, whether a provider balance bills a patient, after the assignment when seeking payment from the health plan, is irrelevant. The court explained why:
We are aware of no circuit court that has accepted [the] defendants argument. The flaw in [the] Defendants argument is that they would treat as determinative Spinedexs patients injury in fact as it existed after they assigned their rights to Spinedex. We agree with [the] Defendants that Spinedex has not sought to recover from its patients any shortfall in Spinedexs recovery from the Plans, and that the patients have not suffered injury in fact after assigning their claims. But the patients injury in fact after the assignment is irrelevant. As assignee, Spinedex took from its assignors what they had at the time of the assignment. At the time of the assignment, Plan beneficiaries had the legal right to seek payment directly from the Plans for charges by non-network health care providers. If the beneficiaries had sought payment directly from their Plans for treatment provided by Spinedex, and if payment had been refused, they would have had an unquestioned right to bring suit for benefits, according to court documents.
While Defendant United Healthcare prevailed in certain other claims, the Ninth Circuit concluded:
We hold that Spinedex had Article III standing to bring benefit claims against Defendants as assignee of its patients. Its injury in fact is the same injury its assignees had at the time of the assignment. according to court document.
The best explanation, for out-of-network ERISA patient protections, is from DOL Obama administrations Amicus Brief and oral arguments in this case:
Thousands of healthcare claims are made in this country every day, and some are litigated, and yet no circuit court has ruled that providers must first bill their patients before they may enforce legitimately assigned benefits claims. . Limiting physicians first recourse to their patients will have chilling effects both on providers and plan participants. Participants may forgo or delay vital healthcare because they cannot finance or they cannot pay for their care, and providers may limit their care to those participants whose health plans have previously paid properly assigned healthcare claims or participants who are able to first to pay for the care, or the provider can recognize as creditworthy. according to court audio records.
DOL oral argument recording: http://cdn.ca9.uscourts.gov/datastore/media/2014/04/07/12-17604.wma
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 14 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry Godfather of ERISA claims for healthcare providers.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.
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