Summary Plan Description For In And OON Providers: How To Read, Analyze and Interpret An SPD

Recorded Webinar | Thomas J. Force | From: Oct 04, 2021 - To: Dec 31, 2021

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Recording
   $229  
DVD
   $249  
Recording + DVD
   $389  
Transcript (Pdf)
   $229  
Recording & Transcript (Pdf)
   $379  
DVD & Transcript (Pdf)
   $389  


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Why is the Summary Plan Description Important to Out-of-Network Providers

As an employer sponsoring ERISA-covered health and welfare plans, you are legally obligated to communicate the terms of the plan to participants in a summary plan description (SPD). But many plans operate under poorly worded SPDs and leave their sponsors open to liability. You should know how to create a clear and comprehensive SPD so that you can avoid expensive litigation in the future. 

In this web session, expert speaker Thomas Force will help you understand what a summary plan description is, what information ERISA requires to be included in the document, and the importance of the information to providers – particularly out of network (OON) providers. You will also learn how to understand the language and terminology of the summary plan description, how to ascertain the important information to determine the amounts allowably, what your appeal rights are, and what procedures are medically necessary. 

After attending this session, you’ll be able to read, analyze, interpret, and summarize a summary plan description. You’ll also be able to correctly determine the allowable amounts and medically necessary procedures. Plus, you’ll know your appeal rights – and how to maximize your payment of claims. 

Webinar Objectives:-

After attending this webinar, you will learn:

  • The difference between the Summary Plan Description and the Plan Document and the Insurance Certificate.
  • What to look for in the SPD is important to increase claim reimbursement.
  • How to determine what services are considered medically necessary.
  • The internal appeal rights afforded to the patient/provider.
  • How eligible expenses are determined.
  • About external appeals and independent review of claims.
  • What the maximum allowed amounts are based on and calculated.
  • The importance of requesting the plan documents.
  • What documents and information they are entitled to from the insurance company and employer.

Webinar Agenda:-

  • What is a Summary Plan Description?
  • What is a Plan Document?
  • What is an Insurance Certificate?
  • Why is the Summary Plan Description important to out-of-network providers in particular
  • How are allowed amounts determined?
  • What are the patients’/providers’ appeal rights?

Who Should Attend?

  • In and Out-of-Network Providers
  • The staff of Medical Professionals and Facilities 
  • Healthcare billing companies
  • Healthcare Attorneys

Thomas J. Force

Thomas J. Force, Esq.

As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance Officer propelled the founding of The Patriot Group. The Patriot Group is a full service revenue recovery company that provides billing, collections, and follow-up services as well as assistance with managed care appeals, managed care contracting, credentialing and compliance. Mr. Force is nationally recognized as an expert in revenue collection techniques, managed care contracting and appeal strategies. Mr. Force remains an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, the Suffolk County Bar Association, and other organizations. A United States Marine, Mr. Force received the prestigious Meritorious Mast Award for Leadership in 1987. Mr. Force is also co-Chairman of the Health and Hospital Committee of the Suffolk County Bar Association. He is co-founder of the Healthcare Reimbursement Attorneys Network, a national association of attorneys that represent physicians and hospital clients. Mr. Force also works closely with the American Medical Association and various state Medical Associations.