Archives March 2015

CIGNA’s ERISA sword backfires – ERISA “shining armor” used to protect out-of-network providers as federal district court rules against CIGNA! District Court dismisses all of CIGNA’s Claims and grants out-of-network Humble Surgical Hospital motion in its entirety.

On March 24 2015, a federal district court in Houston, Texas ruled against CIGNA and dismissed all of its claims. The district court ruled in favor of out-of-network provider, Humble Surgical Hospital (HSH), by granting its motion on judgement in its entirety due to ERISA preemption, lack of ERISA fiduciary legal standing and failure to sufficiently plead remaining claims. In an interesting irony, here it was the provider, HSH, which argued for ERISA preemption and CIGNA’s lack of standing, signaling a turning point in out-of-network claim disputes.

The lawsuit is part of a larger trend in out-of-network reimbursement battles. The decision sheds light on the “out-of-network fraud” enigma and is one of a series of critical court decisions which address the typical scenario for out-of-network providers: payors refusal to pay claims which leads to “catch-all” out-of-network lawsuits seeking total overpayment refunds of claims previously paid, all based on broad and vague allegations of fraud.

In a common fact pattern for out-of-network providers, CIGNA’s state law fraud and ERISA overpayment lawsuit alleges improper billing, fee-forgiving, deductible waiver fraud, negligent misrepresentation, unjust enrichment and allegations the hospital physician-owner received improper kickbacks from unlawful referrals.

Avym Corporation (Avym) advocates for new ERISA out-of-network specialist programs and litigation support services to assess, educate and comply with this court decision. Avym provides comprehensive and in-depth assessments of this and a string of other court decisions to demystify ERISA legalese for both non-lawyer healthcare providers and seasoned healthcare attorneys.

Moreover, this court decision provides comprehensive legal and practical guidance for the entire managed care business model and health plan benefits industry.  As more health plans are determined to contain costs, likewise, more healthcare providers are determined to provide patients with high quality, affordable healthcare while continuing to support patient’s freedom to select their out-of-network medical services.

“Timely education and understanding of this court decision will bring peace, harmony and compliance to the healthcare industry”, according to Dr. Jin Zhou, President of ERISAclaim.com and national expert on ERISA compliance and appeals.

Case info:
Connecticut General Life Insurance Company, et al. v. Humble Surgical Hospital, LLC, Civil Action No. 4:13-Cv-3291, on 03/24/15, in the United States District Court, Southern District of Texas. (Cigna v Humble Surgcal Hospital LLC)

Avym’s new out-of-network specialist programs will analyze this decision in the following sessions:

I. Court’s summary of this lawsuit as part of a larger trend in out-of-network reimbursement battles:

“The plaintiffs, Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company (collectively, “Cigna”), bring suit against the defendant, Humble Surgical Hospital, LLC (“HSH”), to recover alleged overpayments made to HSH for out-of-network services. The complaint (ECF No. 1) asserts various state common law claims sounding in tort, as well as claims for declaratory and injunctive relief. Alternatively, Cigna seeks equitable relief under the Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. Pending before the Court is the defendant’s FED. R. CIV. P. 12(c) motion for judgment on the pleadings, which challenges the complaint based on theories of ERISA preemption and statutory standing (ECF No. 16). The plaintiffs filed an opposing response (ECF No. 21) and the defendant timely replied (ECF No. 31). Having reviewed the pleadings, motion, responsive documents and applicable law, the Court determines that HSH’s motion should be GRANTED in its entirety.”

according to court document.

II. Court’s conclusion and practical guidance for the entire managed care business model:

“CONCLUSION: Based on the foregoing analysis and discussion, the Court concludes that ERISA preempts all state claims arising from Cigna’s self-funded plans and employee benefit plans. Cigna has not alleged sufficient facts to establish standing to sue under ERISA nor has it alleged sufficient facts to establish the existence of any plan from which its non-ERISA claims arise. As pleaded, Cigna’s state and federal claims are deficient. HSH’s motion for judgment on the pleadings is therefore GRANTED and Cigna’s complaint is dismissed.”

according to court document.

III. Court’s summary of CIGNA’s specific complaints against Humble Surgical Hospital:

“Based on these allegations, Cigna asserts state law claims for money had and received, common law fraud, negligent misrepresentation and unjust enrichment. Under these theories, Cigna seeks restitution of overpayments it made to HSH for “false and excessively billed services.” Cigna also seeks injunctive relief requiring HSH to disclose the referral arrangements it has made with physicians, especially those who have an ownership interest in HSH. The injunction would also enjoin HSH from charging unreasonable fees and waiving patient responsibility for its out-of-network services. Additionally, Cigna seeks a declaratory judgment that HSH’s billing practices violate various Texas statutes and that Cigna is entitled to recoup all overpayments paid to HSH. Alternatively, Cigna seeks equitable relief under ERISA, 29 U.S.C. § 1132(a)(3), “to the extent this dispute involves the exercise of Cigna’s discretion under an ERISA plan.”

according to court document.

Avym is dedicated to empowering providers with ERISA appeal compliance and ERISA litigation support in all cases as well as ERISA class actions.  All medical providers and Plans should understand several critical issues regarding the profound impact of this court decision on the nation’s No. 1 health care claim denial – overpayment demand recoupment and offsetting; including how to correctly appeal every wrongful overpayment demand and subsequent claims offsetting with valid ERISA assignment and the first ERISA permanent injunction.  In addition, when faced with pending litigation and or offsets or recoupments, providers should look for proper litigation support against all wrongful overpayment recoupment and offsetting, to seek for enforcement and compliance with ERISA & PPACA claim regulations.

A recent Federal 5^th Circuit Court decision thwarted CIGNA’s potentially discriminatory “out of network protocol” policy against non-contracting providers and facilities. The decision allows properly assigned out-of-network providers Article III legal standing to sue and to challenge CIGNA’s potentially discriminatory “out of network protocol” under ERISA.

The 5^th Circuit Appellate court questioned whether CIGNA’s denial of claims to Out of network providers who did not collect all patients’ deductibles and co-payments but NON denial of claims for in network providers who did the same (also known as CIGNA’s “fee-forgiving protocol” to reduce payments) violated ERISA anti-discrimination laws. According to the court:

 “Also relevant is whether Cigna denied all coverage to patients who were not charged or ‘billed’ for their copays or coinsurance by in-network providers.”

Health plan discrimination is not only wrong in principle, but is without justification based on the quality of health care provided by non-contracted providers. All patients should have the right to choose and be reimbursed for all health care services provided by non-contracted providers without impediments and limitations that unfairly restrict their freedom of choice. Anti‐competitive and discriminatory obstacles only serve to drive up costs, limit patient choice and erode the quality and necessity of health of care.

According to the Senate Committee on Appropriations Report dated July 11, 2013, “The goal of [section 2706 of the PHS act] is to ensure that patients have the right to access covered health services from the full range of providers licensed and certified in their State.”

Since its inception in 2010, the Patient Protection and Affordable Care Act (PPACA) claims regulation adopted longstanding ERISA claims regulations in their entirety for all health plans.

PPACA §2706 specifically prohibits plan’s discrimination against any health care providers solely based on their participation in plan TPA’s PPO networks with respect to health plan coverage when they are acting within the scope of their license under state laws. Section 2706 applies to all employee health benefit plans (insured and self-insured) and all health insurance policies.

Section 2706(a) of the Public Health Service Act preserves those protections by creating a federal provider non-discrimination provision that applies to all plans regulated by PPACA. Section 2706(a) prohibits insurance providers from discriminating, with respect to participation under the plan or coverage against health care providers acting within the scope of their state license of certification.

`SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.

`(a) Providers- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

`(b) Individuals—The provisions of section 1558 of the Patient Protection and Affordable Care Act (relating to non-discrimination) shall apply with respect to a group health plan or health insurance issuer offering group or in-dividual health insurance coverage.(http://www.dol.gov/ebsa/pdf/affordablecareact.pdf page 97)

As established by this landmark 5th Circuit Court ERISA ruling, federal courts have clarified, for the first time, ERISA anti-discrimination protections for both in and out-of-network patients and providers. Furthermore, this court decision may have exposed a fundamental legal flaw in the nation’s managed care business model.

The implications of this case will reverberate across the healthcare industry. It will have profound ramifications for all professionals involved in healthcare including insurance carriers, medical providers, plan sponsors, plan administrators, TPA’s, attorneys and of course patients.

Avym Corporation promotes  new ERISA out-of-network specialist programs and litigation support services to assess, educate and comply with this appellate court ERISA decision. This decision is a true harbinger of things to come and can be used as a “crystal ball” to help understand alleged out of network fraud mysteries.

Avym Corporation provides comprehensive and in-depth assessments of this landmark decision and will demystify ERISA legalese for both non-lawyer healthcare providers and seasoned healthcare attorneys. This is a critical court decision, which addresses a typical scenario for out of network providers: refusal to pay claims then a catch-all, out of network lawsuit seeking complete overpayments based on broad and vague allegations of fraud.

Avym is dedicated to empowering providers with ERISA appeal compliance and ERISA litigation support in all cases as well as ERISA class actions.  All medical providers and Plans should understand several critical issues regarding the profound impact of this final court decision on the nation’s No. 1 health care claim denial – overpayment demand recoupment and offsetting; including how to correctly appeal every wrongful overpayment demand and subsequent claims offsetting with valid ERISA assignment and the first ERISA permanent injunction.  In addition, when faced with pending litigation and or offsets or recoupments, providers should look for proper litigation support against all wrongful overpayment recoupment and offsetting, to seek for enforcement and compliance with ERISA & PPACA claim regulations.

For more information or to contact AVYM

More fallout from the recent Fifth Circuit Court of Appeals decision against Cigna: wide ranging implications for out of network provider reimbursement paradigm on a nationwide scale; 3rd party “re-pricing negotiation” agreements and (Non PPO) discounts would be preempted by ERISA if: “[t]he contracts by their terms are subject to the underlying ERISA plans”

In a recent federal appeals court decision, the court ruled against CIGNA and in favor of Out-Of-Network (OON) providers. All Out of network providers should be aware of the practical implications of this appellate court opinion; namely, that it allows out-of-network providers the right to sue, under ERISA, for all eligible payments under the plan terms, regardless of any third party cost containment or negotiation agreements (Non-PPO Discount Agreements) which are usually negotiated by intermediary companies on behalf of Cigna.

According to the appellate court’s ruling, Third Party “re-pricing negotiation” agreements and discounts will be preempted by ERISA if: “[t]he contracts by their terms are subject to the underlying ERISA plans”.

Even after re-pricing discounts have been negotiated, OON providers, with valid and complete assignments, have the right to seek all eligible payments according to the plan terms.  The profound impact of this appellate court ruling may fundamentally change the nation’s healthcare landscape and existing managed-care model.

Case Info:

North Cypress Medical Center Operating Company, Limited; North Cypress Medical Center Operating Company GP, LLC, v. CIGNA Healthcare; Connecticut General Life Insurance Company; CIGNA Healthcare of Texas, Incorporated, Case No. 12-20695, in the United States Court of Appeals for the 5th Circuit, filed on March 10, 2015. 

Related 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.

In its decision, the Fifth Circuit identifies Third Party “re-pricing negotiation” agreements and (Non-PPO) discounts relation to ERISA plans, as “[t]he contracts by their terms are subject to the underlying ERISA plans”.

The Court sheds some light on the issue:

“We turn next to the grant of summary judgment against North Cypress’s state contract law claims. According to the hospital, Cigna breached the terms of the “Discount Agreements”—contracts between North Cypress and Cigna requiring Cigna to pay a negotiated amount for specific insurance claims. The contracts by their terms are subject to the underlying ERISA plans.”

according to court documents.

OON providers typically receive “re-pricing” and discount requests every day, with little or no options-Until now. The fifth circuit decision has clarified OON provider’s ERISA legal standing to sue; and managed care contracting or re-pricing discount agreements cannot substitute or replace ERISA claim regulations.

The Fifth Circuit first addressed the district court’s ruling that ERISA did not preempt:

“The district court first addressed whether the Discount Agreement claims were preempted by ERISA, which “supersede[s] any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.” This provision is “intended to ensure that employee benefit plan regulation would be ‘exclusively a federal concern,’” and as such, the Supreme Court has commented that the preemption provision is “conspicuous for its breadth” and is “deliberately expansive.” Nonetheless, the district court found that the contract law claims were not preempted because North Cypress could not bring the claims under ERISA….The court went on to rule on the merits, finding no breach because Cigna was entitled to reduce payment under the terms of the “Discount Agreement” contracts.”

according to court documents.

The Fifth Circuit vacated the district court’s non ERISA preemption decision and found for North Cypress’ ERISA legal standing to sue, and remanded for ERISA preemption consideration for (Non-PPO) Discount Agreement contracts:

“In holding that North Cypress has standing to bring ERISA claims, we removed the foundation of the district court’s preemption ruling. The parties have not briefed the issue of whether the Discount Agreement claims nonetheless survive un-preempted. Accordingly, we vacate the grant of summary judgment and remand so that the district court may consider the question of preemption in light of our ruling on standing.”

according to court documents.

Avym is headquartered in in Los Angeles, CA and is the leading provider of ERISA/PPACA health claim appeal services, reimbursement compliance, overpayment recoupments and offsets appeals, dead claims recovery services and ERISA/PPACA healthcare claim litigation support services.  To get more information or to contact Avym, click here.

The other shoe drops on insurer’s attempts to limit payments to providers and discourage patient out-of-network utilization based on patient deductibles and co-pays. 5th Circuit decision signals shift towards providers in out of network reimbursement disputes.

In a much anticipated second case regarding out-of-network provider’s right to sue and whether coverage may be conditioned on collections of patient’s out of pocket costs, the Fifth Circuit Court of Appeals ruled against Cigna in a decision that is consistent with a recent Ninth Circuit judgment against UnitedHealth Care. The ruling against Cigna’s “fee forgiving protocol” allows out-of-network provider’s the right to sue for ERISA violations in federal court and it also allows out-of-network patients the right to both ERISA discounts and PPO discounts.

In an unprecedented turn, the 5th Circuit ruling provides very specific step-by-step ERISA legal guidelines used in determining whether all ERISA plans improperly require collection of full deductible and coinsurance as a pre-condition  to complete benefits coverage and whether CIGNA violated federal ERISA law in its inconsistent or discriminative out-of-network practice compared to its in-network practice of ERISA plan claims administration services.

Case Info: North Cypress Medical Center Operating Company, Limited; North Cypress Medical Center Operating Company GP, LLC, v. CIGNA Healthcare; Connecticut General Life Insurance Company; CIGNA Healthcare of Texas, Incorporated, (North Cypress Medical Center v. Cigna)Case No. 12-20695, in the United States Court of Appeals for the 5th Circuit, filed on March 10, 2015.

This landmark decision may potentially save millions of Americans from medical bankruptcy. It also illustrates one of the most pressing issues facing out-of-network patients and providers across the nation.  Deductible and Co-Pay waiver claim denial is the No. 1 out-of-network claim denial reason, contributing to increases in the number of personal bankruptcies. According to many recent surveys, reports and case studies, one in five American adults will struggle to pay medical bills. In fact, medical bills are the leading cause of personal bankruptcy, affecting even those with health insurance. Subsequently, approximately 76% of Americans paid for out-of-network coverage through their employer-sponsored health plans, according to a December 2013 National Composition Summary from DOL Bureau of Labor Statistics. It’s clear that the epidemic of out-of-network deductible balance billing wrongly imposed by ERISA plans has inevitably contributed significantly to unexpected medical bills and personal bankruptcy.

In light of other recent court filings this federal court decision, on deductible and co-payment collection practices, paves the way for millions of out-of-network ERISA plan participants and their beneficiaries by ruling out-of-network ERISA discounts must and should be treated consistent to in-network PPO discounts.

Inspired by this and other recent court decision, Avym Corporation announces new ERISA Out-Of-Network Claims Specialist training programs strictly in accordance with this most comprehensive federal appellate court decision:

“There are strong arguments that Cigna’s plan interpretation is not “legally correct,” in which case the inquiry proceeds to determine whether Cigna nonetheless had discretion to interpret the plan as it did. On a finding that the plans, read correctly, do not condition coverage on collection of coinsurance, the question would be whether Cigna nevertheless had discretion to absolve itself of responsibility for payment of the greater part of thousands of claims…”

according to court documents.

In this CIGNA case, the out-of-network hospital provider’s medical claims were denied by CIGNA in whole or in part on the basis that all patient deductible’s and coinsurance amounts were not collected in full or billed for by the hospital. The Fifth Circuit ruled for the hospital’s ERISA right to sue and outlined legal steps under ERISA to determine if an ERISA plan truly requires collection of deductibles and balance billing in full:

“Cigna argues that if we find standing we ought nonetheless to affirm the grant of summary judgment against North Cypress’s benefit underpayment claims on the merits; that its reading of the plan language was “legally correct” or otherwise within its discretion, and that its actions rested on “substantial evidence.”57 …. The “most important factor to consider” in the legal correctness inquiry is whether Cigna’s “interpretation is consistent with a fair reading of the plan[s].”

according to court document.

The court goes on explain whether CIGNA violated ERISA:

“The inquiry is thus whether ordinary plan members who read that “payment for the following is specifically excluded from this plan: . . . charges for which you are not obligated to pay or for which you are not billed,” would understand that they have no insurance coverage if they are not charged for coinsurance. That is, would a plan member understand the language to condition coverage on the collection of coinsurance, rather than simply describing the fact that the insurance does not cover all of a patient’s costs…..There are strong arguments that Cigna’s plan interpretation is not “legally correct,” in which case the inquiry proceeds to determine whether Cigna nonetheless had discretion to interpret the plan as it did.”

according to court document.

Finally, the court rejected CIGNA’s argument regarding collection of deductible and coinsurance and explained that an out-of-network patient has the same ERISA rights as an in-network patient for deductible and coinsurance obligations under ERISA plans:

“Also relevant is whether Cigna denied all coverage to patients who were not charged or “billed” for their copays or coinsurance by in-network providers.”

according to court document.

North Cypress Medical Center Operating Co. DOL Amicus Brief, in support of plaintiffs-appellants, and requesting reversal

Recording of Oral Arguments

Avym is dedicated to empowering providers with ERISA appeal compliance and ERISA litigation support in all cases as well as ERISA class actions.  All medical providers and Plans should understand several critical issues regarding the profound impact of this final court decision on the nation’s No. 1 health care claim denial – overpayment demand recoupment and offsetting; including how to correctly appeal every wrongful overpayment demand and subsequent claims offsetting with valid ERISA assignment and the first ERISA permanent injunction.  In addition, when faced with pending litigation and or offsets or recoupments, providers should look for proper litigation support against all wrongful overpayment recoupment and offsetting, to seek for enforcement and compliance with ERISA & PPACA claim regulations.

For more information or to contact AVYM

After Resolution Of Contract Negotiations, Is Damage To Members Ignored? ERISA Class Action Filed Over Medical Claim Denials; Alleges Thousands Of Pre-Approved Medical Claims Unpaid, Members Left Holding The Bag; Possibly Delay Ratification Process?

On February 26, 2015, just days after the Obama Administration sent in Labor Chief Thomas Perez and a settlement was negotiated between ILWU members and the PMA, the International Longshore Workers Union-PMA Coastwise Welfare Plan was slapped with a new class-action lawsuit alleging ERISA violations and fraud for its failure to pay possibly hundreds of millions of dollars in pre-approved benefit claims, as reported by the Los Angeles Times newspaper. The lawsuit offers hope to the thousands of members that have had pre-authorized claims denied, according to court records.

“This is about protecting the rights of American workers. It is unconscionable that a health plan would deny pre-authorized, covered medical claims from a cancer patient, thereby denying needed chemotherapy. Every health plan must comply with all applicable federal laws, ERISA and PPACA claims regulations, as well as statutory fiduciary duties, for the millions of hard-working American workers and families. Otherwise we will have a real life John Q on our hands.” said Esmeralda Alfaro, Co-Lead Counsel for the class plaintiffs.

Despite protests from thousands of ILWU members throughout CA and numerous “work stoppages” over the last 2 years and a formal complaint to the Department of Labor, EBSA Assistance and Complaints, the PMA welfare plan has allegedly refused to pay pre-authorized medical claims. The result has been calamitous for members and their relatives according to the court documents. Many have foregone much needed medical care and some have had mortgage loan applications denied due to adverse credit ratings linked directly to unpaid medical claims.

According to the complaint, the Plan’s own independent fact finder confirmed there were “286,000 unprocessed claims” at one point and the “backlog became worse, with about 90,000 new claims each month” added to the backlog.  The suit also alleges that the plan attempted to  “delay processing of legitimate claims, increasing interest income for the Plan’s fund” as well as create the “misimpression that the PMA Trustees have been diligent in the exercise of their fiduciary obligations”, according to court documents.

In accordance with this ERISA class action filing, Avym Corporation announces new comprehensive ERISA and PPACA Out-Of-Network (ONET) Medical Claim Appeal and Litigation Support Programs in accordance with the most recent federal court decisions. Avym Corporation provided plaintiff providers with ERISA appeal compliance and ERISA litigation support in this provider ERISA class action and Avym’s support services were instrumental in allowing multiple plaintiffs the chance to fight back.

Case Info: Amijo et al v. ILWU-PMA Coastwise et al U.S. District Court for the Central District of CA (Western Division- Los Angeles) Civil Docket for Case #: 2:15-cv-1403, Filed 02/26/2015.

This class action lawsuit comes on the heels of successful contract negotiations between the International Longshore Workers Union and the Pacific Maritime Association, a group of West Coast terminal operators. While the settlements still have to be ratified by union members, it remains unclear whether ILWU members view the class action lawsuit as an obstacle to delaying the ratification process. The implications of any delay in ratifying the agreements could be enormous.

According to the lawsuit,

• ILWU-PMA has been intentionally withholding and delaying payments from patients and providers on legitimate claims, thereby increasing interest payments to the Plan’s fund in violation of ERISA;
• ILWU-PMA misleads patients and providers by creating the “misimpression that the PMA Trustees have been diligent in the exercise of their fiduciary obligations” when in fact the claim back log was increasing at a rate of 90,000 additional claims per month;
• ILWU-PMA has never complied with ERISA claims regulation nor its own claims procedures by failing to provide “meaningful grievance and appeal procedures” effectively denying full and fair reviews of appealed claims in violation of ERISA;
• ILWU-PMA’s refusal to pay claims has resulted in many members and their beneficiaries foregoing medical care or treatment that is covered by the Plan to avoid damage to their credit rating or additional personal liability for covered services not paid by the Plan;
• ILWU-PMA has intentionally discouraged members and beneficiaries from seeking services from Out-of-Network providers due to the prospect of complete denials of covered, pre-authorized services, in violation of ERISA;

The putative class on behalf of all similarly situated members and providers is seeking for ERISA benefits payments due, injunctive and declaratory relief and removal of the PMA Trustees among other claims.

Avym Corporation’s ONET UCR ERISA Medical Claim Appeals and Litigation Support Programs will systematically demystify this ERISA class action lawsuit, with particular focus on the essential elements of ERISA claims regulation, successful ERISA administrative appeals as the prerequisites for ERISA judicial reviews on behalf of all similarly situated patients and healthcare providers.

The class action also alleges additional ERISA violations by ILWU-PMA for withholding newly adjudicated claim payments even after the claims were “pre-authorized” and or “pre-priced” by the plan and it’s agents. In particular, the complaint alleged the plan “now routinely denies, or fails even to process, most or all new claims for services of out-of-network Providers.”

The Complaint goes on to allege that: “Plaintiffs are informed and believe, and based thereon aver, that Defendants have paid only a few claims for reimbursement for medical expenses for services of out-of-network Providers in over one year, causing financial hardship to Participants and Beneficiaries, who by contract or otherwise are liable to Providers if the Plan does not pay. Such intentional refusals to pay also cause hardship to Providers, who are owed substantial sums, and make it increasingly difficult for Providers to continue to serve Participants and Beneficiaries, because of the growing realization that they will not be paid timely or at all.”

This ILWU-PMA case illustrates the need for all employer sponsored health plans to comply with federal ERISA regulations when making benefits determinations and payments.  Additionally, Providers need to level the playing field by ensuring they submit ERISA/PPACA compliant appeals which properly request due process and a full and fair review.

Located in Los Angeles, CA, AVYM is a leading provider of services focusing entirely on the resolution of denied or disputed medical insurance claims by participating in the nation’s first ERISA PPACA Claims Appeals Certification program.  AVYM also 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 services.