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
Will the No Surprises Act be Implemented as Lawmakers Intended?
Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he … [Read more...] about Will the No Surprises Act be Implemented as Lawmakers Intended?
NY Lawmakers Reignite Single-Payor Bill
Reportedly, the New York Health Act which aims to replace employer-based private health insurance and force all New Yorkers onto a government-run healthcare plan is expected to be introduced by Senator Gustavo Rivera, chairman of the state’s Senate … [Read more...] about NY Lawmakers Reignite Single-Payor Bill
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part II: Verification of Benefits — A Vital Process Re-Examined
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
Finding the Sweet Spot Under Surprise Bills
Congratulations to the Cohen Howard Surprise Bill team who recently handled a New Jersey Surprise Bill claim for our client, an out-of-network plastic surgeon. Following submission of our arbitration brief, the arbitrator determined our client’s … [Read more...] about Finding the Sweet Spot Under Surprise Bills
Ninth Circuit Court Holds ER Providers Have Independent Legal Claim Against United Healthcare
OON Emergency Providers Challenging United Healthcare Recently, in Emergency Group of Arizona Professional Corporation, et al., v. United Healthcare, Inc., 838 Fed. Appx. 299 (9th Cir. 2021) a group of out-of-network emergency medical providers … [Read more...] about Ninth Circuit Court Holds ER Providers Have Independent Legal Claim Against United Healthcare
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part I: The All Powerful In-Network Exception
An often-underutilized and misunderstood strategy for maximizing out-of-network provider reimbursements for surgical services is the ‘in-network’ or ‘gap’ exception that can be authorized by health insurance companies on a case by case basis. … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part I: The All Powerful In-Network Exception
Out-of-Network Arbitrations Yield Favorable Results For Providers
The New Jersey Department of Banking and Insurance (‘DOBI’) has published statistics tracking the number of Surprise Bill cases submitted to Maximus Federal, the DOBI contractor handling arbitration cases under the New Jersey Out-of-Network Consumer … [Read more...] about Out-of-Network Arbitrations Yield Favorable Results For Providers
Federal Lawmakers Reach a Provider-Friendly Surprise Bill Proposal
The deep divide between insurers and providers over the best approach to end the practice of surprise billing patients appears to be narrowing, according to coverage by Politico published on Friday as new legislation is expected to be part of the … [Read more...] about Federal Lawmakers Reach a Provider-Friendly Surprise Bill Proposal
White House Executive Order Tasks Congress to Act on Surprise Bill Legislation
Last week the White House issued an Executive Order that addressed, in part, healthcare cost transparency and surprise billing. The Administration urged Congress to act on legislation to end the practice of balance billing by December 31, 2020 and … [Read more...] about White House Executive Order Tasks Congress to Act on Surprise Bill Legislation
