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Court Denies BCBSAL Motion to Dismiss Based on Anti-Assignment Clause in Medical Reimbursement Dispute Finding Derivative Standing Exists Under ERISA

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Our client, an out-of-network orthopedics practice group, filed a lawsuit against Blue Cross Blue Shield of Alabama (BCBSAL) to dispute the medical reimbursement for a spinal surgery performed on July 12, 2016. The patient in the suit had coverage … [Read more...] about Court Denies BCBSAL Motion to Dismiss Based on Anti-Assignment Clause in Medical Reimbursement Dispute Finding Derivative Standing Exists Under ERISA

Class Action Suit Filed Against UHC for Denied Breast Reconstruction Medical Claims

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We are pleased to share news of a class action suit that was filed yesterday, in a New Jersey federal court, against United Healthcare (UHC) concerning its ongoing denial of reimbursement for co-surgeons (CO) and assistant surgeons (AS) when … [Read more...] about Class Action Suit Filed Against UHC for Denied Breast Reconstruction Medical Claims

District Court of New Jersey Remands Case to State Court Declaring ERISA Preemption Does Not Apply

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In a recent decision by the District Court of New Jersey between our client, an out-of-network New Jersey based medical practice and Aetna regarding services related primarily to emergency care, the Court granted our client’s motion to remand the … [Read more...] about District Court of New Jersey Remands Case to State Court Declaring ERISA Preemption Does Not Apply

Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part III: How to Decode the True Maximum Value of a Medical Claim

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True Market Value® is pricing tool developed by the car industry (Edmunds) to help consumers navigate the complicated process of negotiating a fair price for a new or used car.  This concept can be adapted by out-of-network providers to calculate the … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part III: How to Decode the True Maximum Value of a Medical Claim

Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part II: Verification of Benefits — A Vital Process Re-Examined

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While most practices understand, the first step towards obtaining optimum reimbursement from an insurance company is to operationalize a consistent and timely verification process. Even with a process in place to verify benefits, however, it is  not … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part II: Verification of Benefits — A Vital Process Re-Examined