How to Know if Your Hospital Needs Help With ERISA Law - Auraven

The Employee Retirement Income Security Act or ERISA is a federal law created to primarily protect workers and their beneficiaries relying on employee benefit plans, pensions, and other group benefits packages. 

How the ERISA law came about is an extensive story, but the law evolved over the years to protect the rights of healthcare providers. The legislation created a formal process allowing medical practices to make insurers pay on claims being rejected, delayed, or recouped. With ERISA, reimbursement follows the guidelines stated in the patient’s employee benefit plans, not the insurer’s self-established rates and policies.

However, many healthcare providers assume that health plan providers have the final say regarding reimbursement decisions. Medical practices then end up carrying millions of dollars in debt from inappropriately denied claims. If this resonates with your hospital’s situation, you may need help with ERISA law. 

In the list below, we delve into the specific circumstances that call for ERISA specialists. Here are the signs that your hospital would benefit from assistance with the ERISA law:

How to Know if Your Hospital Needs Help With ERISA Law

1. Your Insurance Claims Denials Don’t Seem To Be Decreasing

Patient debt is among most hospitals’ most significant liabilities, and one of its biggest sources is underpaid or rejected hospital claims. If you’ve been experiencing difficulties with filing claims and appeals for the services you’ve rendered, undertaking an ERISA appeals process with experts can help you overturn decisions and recover written-off revenue. 


Payers often cite their own policies or local coverage restrictions when denying claims. With that said, it’s worth reiterating that if a patient’s policy doesn’t mention such limitations, ERISA gives you the right to file an appeal.  


The Auraven team has an in-depth understanding of ERISA. We know how to re-examine your underpaid or rejected claims, and then leverage the legislation to help you recover 50 percent of your hospital’s written-off revenue.

2. Your Staff Doesn’t Understand ERISA Law

Truth be told, ERISA is one of the most complex laws out there, and the legislation itself spans more than a hundred thousand pages. This is one of the primary reasons many hospitals are unable to properly file an ERISA appeal — they simply don’t have the workforce and the time to handle the administrative tasks to ultimately ensure a fair review. 

If your staff doesn’t understand ERISA law or lacks the time to oversee claims on top of their responsibilities, you can leave it up to the experts. 


You can work with ERISA specialists like Auraven to ensure the success of your claims. While you’re still tasked with supplying us with all your written-off or bad debt data, we will do the heavy lifting for you. 


We follow a detailed process when reviewing past denied claims to find the best collection or appeals opportunities. So with us as your partner, you can focus on your daily operation while we work hard to maximize the claim recovery process.   

3. You Have a Team Pursuing Insurance Claims — But None for ERISA Appeals

While you may already have a revenue cycle department or team monitoring your insurance appeals, it’s worth noting that ERISA appeals are entirely different. Insurance claims usually follow state-governed processes that heavily rely on the terms outlined in the contract between your patient and their insurer. On the other hand, the federal ERISA law overrules state appeals and looks at the coverages included in the employer’s benefit plans. 


You can let your existing revenue cycle team carry on with monitoring your insurance claims, but it’s best to turn to experts for your ERISA appeals process. They are trained and experienced in maximizing federal law to identify appeal opportunities in previously denied claims.


With Auraven, you can choose to either integrate our ERISA law experts into your team to closely oversee your appeals process or opt for our consultative appeals program if you need a consultant more than an agent. The latter setup lets you reserve a certain number of hours each month to receive expert ERISA auditing and support. 

4. COVID Has Significantly Impacted Your Finances

The pandemic has impacted the way hospitals operate and has placed intense pressure on their resources. One of the most evident challenges brought about by the crisis is the steep decline in non-COVID-19 services, which consequently led to lower revenues. It’s also worth noting that many hospitals initially had to pay for their staff’s personal protective equipment from their operational budgets. 

If the pandemic has severely affected your hospital’s financial situation, exploring revenue recoupment opportunities with ERISA specialists can help you get back up. 


ERISA appeals specialists follow proven processes and use technology to review your accounts and identify inappropriate denials and underpayments. They also have the legal knowledge to recognize optimal areas for recovery, even in aged claims. 


Our ERISA experts take your written-off claims and handle the entire appeals process to help you recoup lost income. You can also choose to have our consultant embedded in your hospital to oversee ERISA claims. 

We offer different solutions to help you explore other potential revenue sources and enable you to continue serving your patients in the best way possible. 

5. Your Revenue Cycle Management Needs Some Work

This may seem like a common sign, but it helps to reiterate the importance of having and overseeing the claims process in hospitals. Not all medical bills are paid on time, so hospitals that don’t have an effective billing and collections process in place often have to deal with reimbursement declines and an increase in overhead costs. 

If you have been struggling with following up with patients or ensuring the success of your reimbursement requests, it’s time to seek professional help with ERISA. 


Working with third-party collections agencies and ERISA specialists can help you closely monitor your claims, catch potential billing errors and ultimately improve your revenue cycle management.  


Our ERISA attorneys and claims specialists leverage their expertise to help you develop innovative solutions to your revenue cycle problem. More importantly, we undertake the ERISA appeals process to ensure the best possible reimbursement or recovery for your denied benefit claims.  

Get Expert Help from Auraven

The federal ERISA law was created and amended through the years to help protect hospitals and other medical practices from inappropriately denied claims and underpayments.

Unfortunately, only a small number of practices truly understand how ERISA works. On top of that, many often struggle to get the reimbursement they deserve according to their patients’ benefit plans. 

If you have been faced with any of the challenges listed above, consider enlisting expert help from the ERISA specialists at Auraven. Whether you need to reclaim written-off revenue or monitor your ERISA claims process moving forward, we have the right revenue recoupment program for you. Contact us today to learn more.