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Monthly Archives: September 2014

  • Fiduciary Responsibilities under ERISA

    Posted on September 17, 2014

    Below is the link to the September 16, 2014 UBA Employer Webinar Series: “Fiduciary Responsibilities under ERISA”

    The Employee Retirement Income Security Act (ERISA) lays out the definition and responsibilities of Fiduciaries. Individuals who oversee employee benefit plans need to understand these requirements. In this webinar we will cover:
    • How a person becomes a fiduciary
    • The duties of a fiduciary (selecting and monitoring service providers, making sure contributions are made on time, providing required disclosures to plan participants, etc.)
    • The importance of creating and following procedures
    • The critical need to read and follow the plan
    • Potential consequences of mismanaging fiduciary responsibilities
    • Ways to manage fiduciary duties and risks
    • Recent developments with fiduciary obligations
    The webinar will focus on group health plan issues, but will also touch upon some of the additional issues that fiduciaries of retirement plans need to consider. As Department of Labor audits of benefit plans become more commonplace, this is a must-see webinar for anyone tasked with overseeing employee benefits.

    Randal M. Limbeck, Shareholder – Jackson Lewis P.C.
    Randal M. Limbeck is a Shareholder in the Omaha office of Jackson Lewis P.C. He specializes in representation of clients in the areas of ERISA, employee benefits, and executive compensation. Mr. Limbeck has represented clients in a broad range of industries and size, with respect to design, document drafting, employee communications, litigation, and assistance in dealings with the IRS and Department of Labor.
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    Please feel free to watch/listen to this whenever it is convenient for you and your staff. It will be available for you to view for the next 11 months. Your name and email are required for registration. There is no cost however this webinar has been approved for one credit hour toward PHR, SPHR and GPHR recertification through the HR Certification Institute. Once you have viewed the webinar, the last page will provide details on receiving the credit hour.

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  • Tips from Paula – The Appeal Letter

    Posted on September 11, 2014

    As health care consumers, there are, unfortunately, circumstances in which we find that our claims have been denied by our insurance companies. Members must keep in mind that it is their right to appeal these denials. While some appeals are the responsibility of the provider (i.e., a hospital did not obtain prior approval for a surgery), this blog will review the steps for a member appeal.

    If a claim is denied, the patient will be informed in writing by the insurance company. There is usually a timeframe involved for the appeal to be submitted. It is very important to make note of this date and to submit the letter before that deadline.

    The appeal package should consist of: (1) An appeal letter written by the member. (2) A letter from the doctor and/or specialist addressing specifics of the case. (3) Any pertinent information from the patient’s medical records. (4) It may also be helpful to include any articles from peer-reviewed clinical journals that support the case and that illustrate medical necessity and positive outcomes.
    When writing the appeal letter it is important to note why the member disagrees with the denial and why they feel the procedure should be covered. It is also important to keep the letter fact-based, concise, and without emotion or anger. The letter should include member identification information, such as policy number, group number, claim number, or other information used to identify the case.

    We always recommend that members save copies of everything that is sent in for the appeal. In addition, if the package is faxed, it is a good idea to print out a fax confirmation page, so that there is a record of the fax being sent within the timeframe allowed. It may also be necessary to submit that documentation to another level if the first level of appeal is denied.

    As the Employee Advocate, I am always available to assist with appeal letter writing and review, and will also help members with coordination of materials, aa well as submission of the appeal itself.