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Cynthia Marcotte Stamer is nationally and internationally recognized for her more than 22 years experience advising and representing ERISA plan sponsors, insurers and others about with health and managed care, accident life, and other benefit and insurance plan matters. Her clients include U.S. and foreign public and private employers, health and other insurance benefit plans, plan fiduciaries, insurers, third party administrators (TPAs), IROs, PPOs, EPOs, HMOs, PPOs, businesses, managing general underwriters (MGUs), 501A organizations, outsourcers, onsite and other occupational medical providers, disease management organizations, utilization review companies, medical case management organizations, medical bill review companies, health plan technology providers, and other health and managed care plan clients.
Known for her high accessibility and ability to respond to triage crisis “Cindy” advises employment based ERISA and other health plan sponsors and other health and managed care plan clients, design and administer programs, manage legal risks and compliance, improve operational effectiveness, investigate concerns, and defend or resolve legal or other challenges through her legal practice, leadership in professional and civic organizations, writings and publications, and policy advocacy.
Cindy’s more than 22 years managed care and insurance experience includes an extensive and diverse resume of work advising and representing public and private employment based, individual and governmental managed care and other health and accident benefit plans; their employer, insurer, government and other program sponsors; insurers; fiduciaries; administrators; technology and outsource service providers; managed care networks; and others about design and documentation, tax treatment, implementation, administration, termination, regulation, interpretation, regulatory compliance, risk management and defense of self-insured and insured employee health plans and products to meet their budgetary goals, business objectives, and applicable legal and operational requirements. Cindy also regularly advises, represents, defends and trains corporate leaders, insurers, risk managers, businesses, boards of directors, fiduciaries, insured and self-insured health plan sponsors and others about legal risks and legal, insurance and other risk management strategies and practices that reduce and resolve a wide range of legal and operational exposures.
Throughout her career, Cindy has worked on the design, development, administration, and defense of health and managed care, occupational injury and worker’s compensation, accident, disability, life, individual and group insurance and employee benefit arrangements. Her experience includes providing cutting edge advice to employer and other employment-based health plans and their sponsors, insurers and others about the design of traditional indemnity, managed care, mini-med and other innovative consumer driven health care, 24 hour, nonsubscriber and other occupational medicine, and other health benefit plans; expatriates, medical tourism, business travel and accident and other international health benefit programs; Medicare, Medicaid, Medicare Part D and other governmental managed care programs; as well as a wide range of other health coverage and benefit arrangements.
As a core focus of her practice, Cindy helps employers, insurers, administrators and fiduciaries to respond to the ever-growing challenges of maintaining and provide health benefits in the face of ever-rising costs and liabilities. Cindy has played a leadership role in the design, implementation and defense of numerous innovative self-insured and insured public and private health and managed care plans and arrangements as well as daily challenges associated with the sponsorship, maintenance and administration of more mainstream health benefit arrangements. Her resume includes significant experience working with employers and other ERISA plan sponsors, health plans, insurance and administrative services, federal and state legislators and regulators; foreign governments and other health benefit industry clients on a diverse range of product development, operations, regulatory, licensure, compliance, claims processing and investigation, data security and privacy, workforce and process reengineering, cost containment, claims processing, public policy, risk management, defense of audits, and other matters. She helps these and other clients to design and innovate, document, administer, interpret, and defend a diverse range of health and other group and individual benefit programs and products. Her work encompasses a lengthy resume of experiences dealing with the full array of U.S. private and public health payment systems, including insured and self-insured health and managed care; health flexible spending accounts (health FSA); health savings accounts (HSA); prescription drugs; wellness and disease management; health reimbursement accounts (HRA); catastrophic heath plans; limited benefit; high deductible reimbursement; expatriate and other private health and welfare benefit policies, programs, plans, and arrangements as well as Medicare Advantage and certain other governmental managed care programs. As part of this work, Cindy regularly is sought out for her knowledge and experience with the development and implementation of consumer driven health plans, high deductible health plans, mini-med, limited benefit, 24-Hour health and disability, disease management, wellness, patient empowerment, on-site medical clinics and other occupational medicine arrangements; ex-patriot medical tourism, and other international health benefit programs; fraternal benefit and other association health benefit arrangements, health savings accounts, health care flexible spending accounts, discount care networks, telemedicine arrangements, Medicare and Medicaid Advantage Plans and processes and other employment and non-employment based health and managed care arrangements and processes.
Cindy continuously advises and updates employers, insurers and other employment-based health plans, plan sponsors, plan fiduciaries, and plan service providers program design and administration, risk management, compliance, operations, contracting, plan documentation and interpretation, and public policy concerns. Her background includes a lengthy resume of advising clients about compliance with federal and state laws and regulations including ERISA, the Internal Revenue Code, COBRA, Mental Health Parity, USERRA, Medicare, Medicaid, HIPAA, employment, state insurance and other laws and regulations; and other regulatory requirements. Cindy also represents and advises clients about compliance with contract review, negotiation and enforcement; patient empowerment and consumer directed health care; plan communications; claims and appeals administration and processing; utilization management; quality assurance; vendor selection, oversight and management; health care and health program product, process and technology design and administration; patient, provider, payer and beneficiary relations; privacy and security; fiduciary responsibility; preemption; and other legal, management and operational matters. She assists employers and other payers and plan sponsors to design, document, administer, and defend these and other health benefit programs, provider and other vendor agreements, claims investigation and administration procedures, and other related practices. Cindy also represents employers and associations; health plans; health and managed care program sponsors, managed care and insurance organizations, plan fiduciaries, technology and other plan vendors and others before federal and state regulators and assists them to respond to regulatory and enforcement changes. She also advises and represents clients in connection with investigations, litigation, audits, and other actions involving the Department of Labor, IRS, Federal Trade Commission, CMS, HHS, Office of Civil Rights, Office of Inspector General, state department of insurance, state attorney general, boards of medicine, and other federal and state regulators. Her experience also includes advice and representation of a broad range of state and local governmental entities, their employee benefit and insurance programs, vendors, and others about procurement, compliance, administration, risk management, disputes, and other related matters. She also advises and represents public and private employers and other clients about legislative, regulatory and other public policy matters affecting health and other benefit plans, workforce, insurance and other matters.
Her managed care and insurance work includes both the review, design, documentation and enforcement of the plans, polices and programs themselves, as well as the drafting, review, negotiation and enforcement of third party administration and other outsourcing, stop loss and other reinsurance, preferred provider organization, provider contracts, and other related arrangements. She drafts and reviews certificates of insurance, summary plan descriptions, notices, marketing, explanations of benefits, privacy practices and other communications, and administration and compliance policies and procedures. She assists employers, health plans, health plan fiduciaries, health insurers, third party administrators, medical bill review, utilization management, online and other payroll and eligibility administrators and systems providers and others to design processes and procedures to administer programs and operations in accordance with applicable regulatory and contractual mandates, maintain privacy and data security, improve operations, improve defensibility, and minimize liabilities.
The author of the “Health Plan Eligibility Toolkit” and the “Claims & Appeals Administration Bootcamp” and a multitude of practical publications and workshops, Cindy has assisted in the development and administration of a wide range of eligibility, online and other enrollment, COBRA and HIPAA, claims and appeals, and other administrative processes and systems, including internet and intranet based electronic eligibility administration and enrollment systems and technologies, communications, and processes. Cindy has extensive experience advising employers, ERISA health plans, insurers, TPAs, self-insured plan fiduciaries and sponsors, medical bill reviewers, and others about ERISA, prompt pay, and other claims investigation and administration, licensure, regulatory, public policy, operations and compliance, tax, and other operational matters. She also has experience designing and defending programs for associations, fraternal benefit societies, multiple employer welfare arrangements, state and local governments, churches, and other non-ERISA regulated groups.
Cindy also is experienced with a diverse array of other insurance and risk products, services and matters. She has experience drafting, reviewing, and negotiating property; casualty; trade credit and letters of trade credit; travel; shipping and other transportation; bonds and security; stop-loss and reinsurance; subrogation, assignment indemnification subcontractor and other risk shifting agreements; liability, disaster, and risk assessment, prevention, mitigation, recovery and response strategies and other risk management programs; compliance plans; errors and omissions (E&O); malpractice and other liability; employment practices liability (EPL); fiduciary liability and other management liability policies and coverage; terrorism business interruption, and cybercrime and other crisis management coverage; and other insurance and risk management products, processes, services, protocols and agreements.
AV-rated and recognized by International Who’s Who of Professionals, Cindy also is widely recognized for her industry leadership and involvement in a broad range of professional and civic organizations, her speaking and training on industry concerns, and her highly respected publications and other writings on these and other matters. A member of the leadership council of the American Bar Association (ABA) Joint Committee on Employee Benefits, the Immediate Past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Vice Chair of the ABA Real, Property Probate and Trust Section Employee Benefits and Compensation Committee and Vice Chair of the ABA Tort & Insurance Practices Workers’ Compensation Committee, Cindy also regularly conducts training, writes, and participates in a wide range of other industry organizations and activities.
Cindy also is the author of hundreds of highly regarded works and training programs on managed care and insurance, employee benefits, tax, and other risk management and compliance matters. She is a popular speaker who regularly conducts training for a host of clients and conferences. A widely published author and highly sought-after speaker recognized for her ability to share complex ideas in practical, easy to understand and apply terms. Her highly regarded publications regularly appear in the American Bar Association, Aspen Publishers, the American Health Lawyers Association, the Bureau of National Affairs, and a host of other publications. Her insights on health care, health insurance, human resources and related matters have been quoted extensively in The Wall Street Journal, Business Insurance, Managed Healthcare Executive, the Dallas Morning News, Managed Healthcare, Health Leaders, Aging Magazine and various other national and local publications. A listing of some of these and other details about Ms. Stamer may be accessed on this website under the Training and Presentations, Articles, Breaking News, Media Mentions, Leadership and Community Involvement and other components of this website.
Clients value Cindy for her ability to provide real time, pragmatic guidance in response to emergent situations, her talent for assisting clients with the complex details involved in the development and implementation of new insurance or benefit products or programs, systems, processes, and other risk management, compliance or business initiatives and her ability to assess and defend disputes and other controversies arising from the administration or operation of these arrangements.
Cindy is board certified in labor and a graduate of Arizona State University and Loyola Law School in Los Angeles. She and her husband,Doug, are the proud parents of two boys. In her spare time, she enjoys time with friends and family, singing, writing, sports, travel, cooking and entertaining, and gardening.
|Selected publications and presentations of Ms. Stamer are available at:|
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