Posts Tagged ‘down’
Cigna On ?Prompt Pay Discount? Fraud? “Down From $2 Million/Month To $200 Thousand/Month” For A Hospital Pay
Cigna On “Prompt Pay Discount” Fraud? “Down From $ 2 Million/Month To $ 200 Thousand/Month” For A Hospital Pay
Hanover Park, IL (PRWEB) January 27, 2012
ERISAclaim.com offers webinars to examine the latest federal court development in an ERISA lawsuit between CIGNA and an out-of-network (OON) hospital, with $ 20 million UCR claim by a hospital and a claim for alleged multi-million dollar prompt pay discount fraud (“fee forgiving”) by Cigna. After the court permitted the hospital’s claim to proceed against Cigna on 03/02/2011, Cigna counter sued the Hospital with a fraud claim against the hospital, under a Cigna antifraud “fee forgiving protocol” to reduce the hospital pay “down from $ 2 million/month to $ 200 thousand/month”. While the Court has yet ruled on the merits of all claims by either party, the court documents show that Cigna has been fully implementing the new “fee forgiving protocol” as an antifraud initiative to deny all out-of-network provider claims, including the alleged “prompt pay discount” fraud.
The Court Case Info: North Cypress Medical Center Operating Co., Ltd. et al v. Cigna Healthcare et al, Case 4:09-cv-02556, Filed: 08/11/2009, United States District Court Southern District of Texas Houston Division.
ERISAclaim.com offers in-depth analysis and timely Court-Watch on this case, as this “ERISA v Discount Fraud” court battle will likely represent the No. 1 health claim denial nationwide for all OON patient and provider claims for 2012, especially in the deductible seasons. It is impossible that every provider can collect every dollar of deductible and co-insurance from every patient in this economy with recession and unemployment rates, while 77% Insured Americans paid for out-of-network coverage in private sectors.
“Cigna will deny ALL OON Claims “in total” with ‘fee forgiving’, while no provider can collect 100% from every patient 100% of the time, therefore this Court case is for every OON patient and provider in USA,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
(http://www.cigna.com/health/provider/medical/forms/pdf/Participant_disclosure_form.pdf)
ERISAclaim.com will also discuss compliant proactive ERISA discount practices and ERISA / PPACA appeals for all claims denials and delays.
According to the Court documents, on March 2, 2011, the federal court permitted the hospital’s ERISA lawsuit to proceed.
According to the Court Document, on November 17, 2007, CIGNA filed a counter-lawsuit against the hospital for alleged “prompt pay discount” (“fee forgiving”) fraud, among other things, as a part of its defense, in the Court:
“This action arises from an ongoing scheme by NCMC to defraud CIGNA through a practice known as “fee forgiving.”
“NCMC’s so-called business model wrecks these incentives. Instead of collecting the co-insurance from CIGNA plan members that their plans require them to pay, NCMC waives those payments. NCMC tells CIGNA plan members that it will bill them as if they were seeing an in-network provider, eliminating any financial difference to the member between using NCMC and using another provider in CIGNA’s network. On top of this, NCMC offers these plan members over-the-top “hotel-like accommodations,” unlike those in any traditional hospital, including “all private patient suites with upscale room accommodations, including trim, flat screen televisions, private baths, and wireless internet.”
“Defendants deny the allegations of the third sentence of paragraph 30, except admit that one CIGNA employee wrote an email on or around February 18, 2009 that stated in part “spend at North Cypress Medical Center has come down from $ 2 million/month to $ 200 thousand/month so all of our hard work is paying off and the pressure is being felt by the physicians in the area as well as NCMC, which is a good thing;” Defendants respectfully refer the Court to that email.”
On December 14, 2011, the plaintiff hospital filed a motion to dismiss CIGNA counterclaim, asserting ERISA preemption.
On Jan 11, 2012, the defendant Cigna filed defendants’ response in opposition to plaintiffs’ motion to dismiss defendants’ counterclaims.
According to Cigna Website, Cigna will deny all OON claims “in total” with “fee forgiving”, including “prompt pay discount” (http://www.cigna.com/health/provider/medical/forms/pdf/Participant_disclosure_form.pdf):
“Notice to Participant regarding “fee forgiving” by providers that do not participate in the CIGNA HealthCare network.
Some non-participating providers may offer to waive the amount that you are obligated to pay when you use your out of network benefits by stating that that they will “accept what insurance pays as payment in full.” This conduct may impact your benefit claim. The amount waived may adversely affect the amount of the benefit under your plan. Claims submitted by providers that engage in fee forgiving may be denied in total or you may be required to pay the non-participating provider and then file a claim for reimbursement.
If a non-participating provider offers to waive or forgive any part its charges, please notify the CIGNA HealthCare Special Investigations Hotline at 1.800.667.7145”
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
Located in a Chicago suburb in Illinois, for over 12 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.
###
Attachments
©Copyright 1997-
, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.
Bad Economy Slows Down Cupid on Valentine’s Day
Bad Economy Slows Down Cupid on Valentine’s Day
New York (PRWEB) February 4, 2009
The National Retail Federation announced a 20% drop in its spending forecast for Valentine’s Day 2009. With the holiday just around the corner, consumers are on the hunt for creative, inexpensive, and meaningful ways to say “I love you.”
One way to reach family members to celebrate the day is through a new service launched today by Grandparents.com called StoryTeller.
This new service allows family members to connect with those near and far by recording their voices and with a few mouse clicks, sending the message by e-mail to family members.
“There’s really no simpler way to share stories and love with your family,” said Amy Goyer, senior VP and relationship expert for Grandparents.com. “It doesn’t require any special equipment. All you need is a phone and a computer with an internet connection so you can access this service at Grandparents.com.”
For the 70 million grandparents out there, it’s a gift to give that is free, simple, and most meaningful: telling in their own voice their own story (and family history) in a message sent directly to the family inbox. And for the 30 million long distance grandparents across the country, StoryTeller fills a major void.
In addition to this new service, Grandparents.com has a wealth of information on how to create inexpensive gifts for those near and dear. Handmade photo collages, iPod playlists, homemade candy, and framed children’s artwork are just a few of the ideas that top the list.
Now, in addition to all of these gift ideas, Grandparents.com is encouraging millions of families to log on this Valentine’s Day and read a book, tell their family story, or simply record and send a quick message of love.
Producers: A VNR and B-roll package is available for download at the following location (copy and paste ftp address into browser URL):
FTP SERVER: ftp://grandparentsvideo.com
USERNAME: storyteller_vnr
PASSWORD: FTPguest
About Grandparents.com
Grandparents.com is a place for today’s new generation of active, involved grandparents to find everything they need to get more smiles, have more fun, and make more memories out of the time they spend with their grandchildren. From thousands of great kid-friendly places and activities, deals and discounts, and expert advice on relationships, personal finance, gift buying and more, there is something for everyone who loves grandparenting. The company is headquartered in New York City and staffed by some of the foremost experts. Free membership, including a weekly newsletter with featured site content is available at http://www.grandparents.com.
###
Attachments
©Copyright 1997-
, Vocus PRW Holdings, LLC.
Vocus, PRWeb, and Publicity Wire are trademarks or registered trademarks of Vocus, Inc. or Vocus PRW Holdings, LLC.
Zooming down the highway connected to the Internet
Article by Carol White
How neat would it be to be rolling along and checking the road conditions, making your next campground reservation or updating your Personal Travel Website? Of course, if you are the driver, we don’t think this is a good idea, but for your co-pilot or other passengers, what a great convenience.
This is now a very real possibility with cellular data cards, also known as “air cards.” The first thing you need to know is that they have nothing to do with your cellular phone service. Forget all about that. What is similar is that they use cellular technology (the towers, routing, etc.), but without those pesky minutes or long distance to worry about.
A cellular data card can be purchased from any cellular carrier (or you can buy your own elsewhere and sign up for the service) and fits into a PCM-CIA or ExpressCard slot on your PC. There is no connection to your cellular phone at all. In fact your cell service and your cellular data service can be from two different providers, however, you may save money if you use the same provider for cell phone and cellular data service.. Your data card has a tiny antenna on it that communicates with the cellular towers and tells them that you are transmitting as a “data only” customer from this device.
The cards themselves range from with rebate up to 0 or so. The service to go with the card ranges from about a month to for unlimited access at the highest speeds, depending upon the provider. All the large cellular companies provide this service;
So where can you use them? You will have Internet access automatically connected anytime that you are in cell phone range. If you can talk on your cell phone, you can let your fingers fly on the Internet. Like your cell phone, you don’t have to be in the service area of your provider – any cell service will do! What you will notice is that different companies have different technologies in both their cards and their service. This will cause some connections to be much faster than others around the country.
If you are a “power user”, it’s important to check the speeds of the cards and the quality of service at locations that you may use frequently. It’s much easier to get a card working fast in urban areas and along main highway corridors than off the beaten path. Just as your cell phone “drops” calls, your data card can “drop” service, either entirely or to a much slower network. If you are a MAC user, you may need to download some scripts to get your card to work – if it will work at all – something to check carefully before you buy. To find the cellular card option that’s best for you, the independent reviews at CNET and PCMag are a good place to start.
If you are having trouble always finding wi-fi “hot spots,” this is another way to connect to the Internet reliably and fairly cost effectively. Of course you can also use these when you are home – depending upon your individual situation, perhaps even in place of your regular Internet service.
So if you travel mostly in areas where you can get cellular service, a cellular data card may be the perfect solution. You can have all your work done before you arrive at your destination and be ready to play – not be buried behind your PC. After all, isn’t that why we have RVs?
About the Author
Carol White is the co-author of the award-winning book, “Live Your Road Trip Dream” (www.roadtripdream.com) – the ultimate road trip planning guide for extended road trips. Carol and her husband Phil have traveled over 50,000 road miles in the past several years, visiting all forty-eight of the contiguous states and having visited all of the National Parks in those states. They now spend their days helping others to live their dreams.
Use and distribution of this article is subject to our Publisher Guidelines
whereby the original author’s information and copyright must be included.
www.digidave.co.uk – Connecting a Sony PSP to the Internet via WiFi (requires access to a wireless access point or hotspot).
Video Rating: 4 / 5