ERISA Watch with Elizabeth Hopkins

On this month’s episode our host Elizabeth Hopkins interviews Ed, a father whose daughter struggled with an eating disorder when she was a teenager over a decade ago. The family had to take out a second mortgage on their home in order to pay for life-saving treatment at a residential facility after their healthcare plan insurer refused to pay and they could obtain no help from the state agency tasked with regulating health insurance. A lot has changed since that time.  But more remains to be done because every day insurance companies still refuse to pay for residential treatment prescribed by doctors for patients suffering from eating disorders and other mental illnesses and these patients are either unable to obtain the treatment they need to recover or their families are forced to go into debt to pay what should be covered by their insurance. 

This month’s episode is dedicated to Karen Ferguson, founder of the Pension Rights Center. The Pension Rights Center is a non-profit organization dedicated to helping people with their pension-related issues and advocating on their behalf. Our host, Elizabeth Hopkins, talks to Karen’s colleague, Norm Stein, about the Pension Rights Center and Karen’s legacy. To find out more about the Pension Rights Center and how you can help, click the link below. https://www.pensionrights.org/

On this special ERISA Watch episode, our host Elizabeth Hopkins examines the upcoming Supreme Court argument in the Hughes v. Northwestern University case, which will be held on Monday December 6, 2021. In Hughes, participants in a defined-contribution retirement plan allege the plan paid too much in fees for the investments offered, but the lower courts dismissed without even considering the merits of the case. Elizabeth speaks to Former Assistant Secretary of Labor, Phyllis Borzi, about the importance the of the investment fee issue and why it matters to anyone with a pension. They discuss how paying too much in fees over the course of a career can potentially cut retirement income for an individual by over one-third, and how management companies are profiting to the tune of many millions of dollars per year by skimming from retirement plans. Paying the vig in this instance might not implicate loan sharks and bookies, but with all of the risk on the plan participants and none of it on the employer and investment managers, the end result of the cuts being taken might not look all that different. 

On this month’s episode, our host Elizabeth Hopkins shines a spotlight on America’s other pandemic, the opioid crisis. Even beyond the tens of thousands of deaths annually, the true effect of this wide-reaching crisis stretches far beyond calculable figures. The multifaceted problem of addiction can only be addressed when we begin with increasing empathy and rejecting the impulse to stigmatize. Elizabeth has a conversation with her colleague Elizabeth Green, and with Elizabeth’s client, Liz Pires, who tells the unimaginable story of losing both of her children, Megan and Matthew, to substance use disorder. Liz describes how frustrating it was  for her that despite having insurance, it wouldn’t pay for what the doctors and medical experts were recommending to treat her children. She wanted her children “to have every chance to overcome this.” Unfortunately, that was not the reality for Megan and Matthew. It’s Liz’s hope that through large-scale societal changes with insurance payments, medical care, and criminal justice reform other moms won’t have to go through what she went through with her own children’s diseases, and other young people can fully recover. You can find out more about Liz Pires’ foundations at:https://lastoverdose.org/ and the Matthew and Megan Endowed Excellence Fund Thank you for listening and look out for Episode 10 on December 3. 

In this special episode, host Elizabeth Hopkins acknowledges the 20th anniversary of September 11, 2001.  This episode is also a check in on how well Congress is living up to its promises to more than 24,000 first responders and heroes. Introduced in 2006 and finally signed into law on January 2, 2011, the World Trade Center Health Program was designed to provide for the physical and mental healthcare for first responders.  It should come as no surprise that the program was outsourced to a private, for profit company (United Healthcare).  How has this worked 20 years later? Elizabeth has a conversation with Michael Gavin, a paramedic from Boston who is among the thousands of heroes called into duty that day. Mike tells us his harrowing story of that day, and the weeks of 12-hour shifts as he and his fellow responders worked endlessly to help in any way they could. As anyone could imagine, Mike suffered for his time at Ground Zero, experiencing substance abuse disorder, PTSD, and ultimately Hodgkins Lymphoma, which happens to be most diagnosed cancers among the 9/11 survivors.Listening to Mike's journey from that day two decades ago to the present, it is almost unbelievable to hear about the re-traumatization Mike and others are experiencing.  For more on Mike's experience, you can find his book "Facing It: Unseen Injuries of a 9/11 First Responder," on Amazon https://amzn.to/39W9oix  Thank you for listening and look for Episode 8 on November 5.

In our 6th episode of ERISA Watch, our host Elizabeth Hopkins discusses one of the things that attracted her about the idea of coming to Kantor & Kantor after a very fulfilling time at the US Department of Labor. Liz appreciated the way the firm helps individuals and their families navigate getting the proper treatment they are promised from their employers through the insurance companies. Specifically, those living with eating disorders. Despite the existence of the Mental Health Parity Act, the acts of gaslighting from doctors on the insurance companies' payroll still happen. Of course this dangerously limits the treatment that is covered.  Believe it or not, in some instances, insurance companies want these individuals to get more sick before approving treatment. How does this ever make sense?In order to give this sordid healthcare and insurance ecosystem a real-life example, Liz has a conversation with Kantor & Kantor's Insurance Advocate Kathleen MacDonald. Listeners will be moved by Kathleen's story of perseverance, hope, and empathy.  In many respects, Kathleen should be considered the successful "after" picture of a person's journey through mental health and eating disorder, all the way to recovery. Even as Kathleen shies away from any spotlight because she knows there are scores more people living through circumstances worse than hers, listeners will benefit from hearing the conversation.As Kathleen stresses in the podcast and in her daily life: To anyone who is living with and through mental health and eating disorder struggles, please know you are necessary, and worth the fight!Please enjoy this episode. Episode 7 will be back on October 1.

In a special 4th of July episode, host Elizabeth Hopkins takes some time to share her thoughts about freedom, equality and labor & employment law.Since July celebrates the day the draft of the Declaration of Independence was completed, Elizabeth took some time to re-read the document, which she calls one of the best breakup documents of all time, "full of hard truths and great one-liners."Upon reflection, Elizabeth asks if we are truly free. Can we truly pursue happiness if we are beholden tp the whims of employers and insurance companies?Hear Elizabeth's own list of grievances, not about King George, but about ERISA.Be on the lookout for our next full episode on August 6. Thank you for listening.

This this episode of ERISA Watch, host Elizabeth Hopkins asks if insurance companies live up to the promise instilled through ERISA, or do they take advantage of the peculiarities of trust law to avoid paying benefits.In a short origin story of the concept of trust, courts of equity, and chancery law, Elizabeth tells how the federal law of ERISA grew out of these historical and societal concepts.To illustrate how these concepts that are governed by ERISA and state laws, Elizabeth has a conversation with Glenn Kantor, one of the nation's premier experts and ERISA litigators. Glenn shared a few stories that show how under ERISA, the insurance companies have been putting their thumbs on the scales of justice so that they and their shareholders profit, while individuals and their families go without benefits they deserve.  Can these things change? As Elizabeth says, history does show that change can and sometimes does happen to meet the needs of the times , and crusaders are often at the forefront of such change.   Please enjoy the episode, and look forward for #5 on July 2.

Here in the United States we have some of the best surgeons, specialists, and some of the best, most innovative treatments in the world. But when the company that runs your health plan refuses to authorize these treatments, what does this mean for the very progress of medicine in this country?In this episode of ERISA Watch, host Elizabeth Hopkins speaks with Aaron Monheim, a 34 year old husband and father of a three year old daughter. Aaron lives with Relapsing- remitting Multiple Sclerosis.  Aaron tells Liz the story of his diagnosis of  and its affect on his life.  All of Aaron's signs showed that he was the perfect candidate for a certain  type of stem cell transplant that would give him the best long-term outcome. Unfortunately for Aaron, the decision makers at Kaiser did not agree. The treatment was deemed experimental and Kaiser refused to authorize these treatment. Elizabeth and Aaron discuss the irony of the fact that even though this stem cell treatment would likely work, and is considerably less expensive than the pharmaceutical counterpart, insurance companies would rather we all use treatment options that are repeatable, and are something we would pay for for years and years.Although in some cases when refusing to authorize treatments, insurance companies have a legitimate foot to stand on. But the problem of standing on one foot is balance.Please enjoy, and be on the lookout for our next episode on June 4

In this episode of ERISA Watch, host Elizabeth Hopkins asks: "When did modern Western medicine decide that mental health was something altogether different than health pertaining to anywhere else in the body?"First Liz speaks with Dr. Joshua Warach, MD, a Neurologist from the Veteran's Administration about their ongoing effort to treat the veterans as holistically as possible, and to de-stigmatize mental health issues. Should the V.A. be a model for commercial healthcare systems?In the area of law and policy, Liz had a chance to speak with Lisa Kantor, Co-Founder of Kantor & Kantor, one of the nation's premier experts in the area of mental health parity, and an advocate for those who suffer from mental illness.  It won't surprise our listeners to know that even though there are mental health parity laws, insurance companies continue to look for avenues through which they can get around these regulations.  Please enjoy, and be on the lookout for our next episode on May 7.

This premiere episode of ERISA Watch, host Elizabeth Hopkins discusses a real life example of how the federal law of ERISA works in the context of today's employee healthcare benefit environment. Elizabeth does this through a conversation with two clients, union members from the entertainment industry.  These men lost access to their healthcare benefits through language and rules with their plans that are quirky at best.  Listen to episode one to learn more about ERISA and to realize how precarious our healthcare is in this country, especially as it is tied to employment.Tune in next month as we discuss mental health parity.

ERISA stands for the Employee Retirement Income Security Act of 1974 and governs most of our employee benefits. While this area of law may not seem as engrossing as other areas of law such as criminal law, the impact labor laws have on our lives are just as compelling and the stakes are just as high. This law blankets areas such as mental health, eating disorders, our retirement accounts, life insurance, and more. Erisa watch will tell stories of individuals whose lives have been dramatically affected and show why Erisa matters.