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	<title>Passion for Subro &#187; Claims Procedures</title>
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	<link>http://www.passionforsubro.com</link>
	<description>The personal subrogation blog of Attorney Adam V. Russo.</description>
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		<title>Inconsistencies and Errors Not Major Enough to Violate Claims Procedure Rules or Overturn Denial</title>
		<link>http://www.passionforsubro.com/claims-procedures/inconsistencies-and-errors-not-major-enough-to-violate-claims-procedure-rules-or-overturn-denial/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/inconsistencies-and-errors-not-major-enough-to-violate-claims-procedure-rules-or-overturn-denial/#comments</comments>
		<pubDate>Sun, 15 Jan 2012 22:21:25 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[California]]></category>
		<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=8434</guid>
		<description><![CDATA[MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 1/12/2012, www.Thompson.com Case: Pacific Shores Hosp. v. United Behavioral Health, 2011 WL 6402435 (C.D. Calif., Dec. 19, 2011) A benefit administrator&#8217;s adverse benefit determination was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for the Central California district concluded [...]]]></description>
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		<title>Surrogate Mother Fails in Bid to Impose State Definitions to Make Plan Pay for Delivery</title>
		<link>http://www.passionforsubro.com/claims-procedures/surrogate-mother-fails-in-bid-to-impose-state-definitions-to-make-plan-pay-for-delivery/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/surrogate-mother-fails-in-bid-to-impose-state-definitions-to-make-plan-pay-for-delivery/#comments</comments>
		<pubDate>Mon, 21 Nov 2011 01:00:53 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Health Insurance]]></category>
		<category><![CDATA[Michigan]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7862</guid>
		<description><![CDATA[Employer’s Guide to Self-Insuring Health Benefits Thompson Publishing                  November 2011      Vol. 19, No. 2  A plan participant cannot pick definitions from various state or federal statutes and impose them on the plan where the plan left terms undefined, if the plan applies a common and ordinary meaning to those terms when asked to justify a [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Medical Opinions Consistent, Claims Procedures Withstand Tests, So Court Won’t Overturn Plan</title>
		<link>http://www.passionforsubro.com/claims-procedures/medical-opinions-consistent-claims-procedures-withstand-tests-so-court-won%e2%80%99t-overturn-plan/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/medical-opinions-consistent-claims-procedures-withstand-tests-so-court-won%e2%80%99t-overturn-plan/#comments</comments>
		<pubDate>Fri, 18 Nov 2011 12:11:48 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7823</guid>
		<description><![CDATA[Employer’s Guide to Self-Insuring Health Benefits        October 2011 &#124; Vol. 19, No. 1  A federal district court upheld a plan’s two-pronged denial of: (1) a patient’s pain treatment falling under its insurer’s experimental services exclusion; and (2) the same patient’s emergency admission in response to complications from the treatment.  The denial was reviewed many times [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Improper Denial Sinks: Plan Asked Reviewers Erroneous Questions</title>
		<link>http://www.passionforsubro.com/claims-procedures/improper-denial-sinks-plan-asked-reviewers-erroneous-questions/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/improper-denial-sinks-plan-asked-reviewers-erroneous-questions/#comments</comments>
		<pubDate>Fri, 18 Nov 2011 12:08:49 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Self-Funding]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7821</guid>
		<description><![CDATA[Employer’s Guide to Self-Insuring Health Benefits        October 2011 &#124; Vol. 19, No. 1  The sponsor of a self-funded health plan abused its discretion in an ERISA claims dispute after it misquoted plan terms during administrative appeals, asking reviewers questions that didn’t reflect plan exclusions, and leading them to affirm the denial when in fact the [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Self-funded Plans Grow</title>
		<link>http://www.passionforsubro.com/claims-procedures/self-funded-plans-grow/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/self-funded-plans-grow/#comments</comments>
		<pubDate>Tue, 08 Nov 2011 01:11:45 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[HHS]]></category>
		<category><![CDATA[Self-Funding]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7725</guid>
		<description><![CDATA[www.myhealthguide.com MyHealthGuide Source: Joanne Wojcik, 10/30/2011, Business Insurance Article Because self-funded health care plans are governed by the federal Employee Retirement Income Security Act, they are exempt from state premium taxes and state laws that mandate minimum coverage requirements making self-funding a less expensive option for employers than traditional commercial health insurance, benefit experts say.According [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>All Quiet on the Transparency Front: Fees Still a Mystery and Hospital Quality Data Spotty</title>
		<link>http://www.passionforsubro.com/claims-procedures/all-quiet-on-the-transparency-front-fees-still-a-mystery-and-hospital-quality-data-spotty-2/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/all-quiet-on-the-transparency-front-fees-still-a-mystery-and-hospital-quality-data-spotty-2/#comments</comments>
		<pubDate>Tue, 08 Nov 2011 01:07:18 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Transparency]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7721</guid>
		<description><![CDATA[www.myhealthguide.com  MyHealthGuide Source: Todd Leeuwenburgh, Thompson Blog on HR and Benefits, 11/3/2011, http://smarthr.blogs.thompson.com and Blog Source Have you asked your doctor or dentist to see his fee schedule? When I did so once, a dentist flatly refused, and as he was showing me the door, he said in effect: &#8220;my prices are higher, but that&#8217;s [...]]]></description>
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		<slash:comments>0</slash:comments>
		</item>
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		<title>Health Care Reform: Summary of Amended Regulations on Claims and Appeal Procedures for Group Health Plans</title>
		<link>http://www.passionforsubro.com/claims-procedures/health-care-reform-summary-of-amended-regulations-on-claims-and-appeal-procedures-for-group-health-plans/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/health-care-reform-summary-of-amended-regulations-on-claims-and-appeal-procedures-for-group-health-plans/#comments</comments>
		<pubDate>Thu, 21 Jul 2011 19:26:34 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Claims Review]]></category>
		<category><![CDATA[Health Care Legislation]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6861</guid>
		<description><![CDATA[www.dwt.com     By Dipa N. Sudra and Jeff Belfiglio     07.14.11 Health care reform requires nongrandfathered group health plans, both insured and self-insured, to change their internal claims procedures and external review procedures. Even as plans work to implement these rules, the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services [...]]]></description>
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		<slash:comments>0</slash:comments>
		</item>
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		<title>Captives Help Create Innovative Programs</title>
		<link>http://www.passionforsubro.com/claims-procedures/captives-help-create-innovative-programs/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/captives-help-create-innovative-programs/#comments</comments>
		<pubDate>Thu, 05 May 2011 19:23:21 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Accountable Care Organizations]]></category>
		<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Claims Review]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6372</guid>
		<description><![CDATA[www.businessinsurnce.com  INNOVATION IS a hallmark of successful leaders in all areas of business, and innovation clearly is a key attribute of the risk managers we honor with our 2011 Risk Manager of the Year award and Risk Management Honor Roll.One striking feature of all the honorees&#8217; risk management programs is the innovative use of captives. [...]]]></description>
		<wfw:commentRss>http://www.passionforsubro.com/claims-procedures/captives-help-create-innovative-programs/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
		</item>
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		<title>When Do PPACA Claims &amp; Appeals Rules Apply?</title>
		<link>http://www.passionforsubro.com/claims-procedures/when-do-ppaca-claims-appeals-rules-apply/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/when-do-ppaca-claims-appeals-rules-apply/#comments</comments>
		<pubDate>Mon, 25 Apr 2011 14:08:41 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Claims Review]]></category>
		<category><![CDATA[PPACA]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6248</guid>
		<description><![CDATA[www.plansponsor.com April 19, 2011 (PLANSPONSOR.com) &#8211; The effective dates for the new claims and appeals requirements under PPACA have changed more than once (even since we&#8217;ve written about this issue before).   Not surprisingly, we have been receiving a number of questions asking us to clarify these various dates.  The Department of Labor issued a grace [...]]]></description>
		<wfw:commentRss>http://www.passionforsubro.com/claims-procedures/when-do-ppaca-claims-appeals-rules-apply/feed/</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<title>Discovery Permitted To Determine Scope Of Administrative Record</title>
		<link>http://www.passionforsubro.com/claims-procedures/discovery-permitted-to-determine-scope-of-administrative-record/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/discovery-permitted-to-determine-scope-of-administrative-record/#comments</comments>
		<pubDate>Wed, 02 Feb 2011 13:31:02 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Claims Review]]></category>
		<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Litigation]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=4814</guid>
		<description><![CDATA[www.healthplanlaw.com January 18, 2011 In the present case, the plaintiff asserts its procedural challenge on the grounds that, given the different versions of the administrative record produced during discovery, many of which lacked important medical records initially provided by the plaintiff, it is impossible to determine what comprises the full administrative record on which the [...]]]></description>
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