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Cohen Howard

Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)

August 12, 2021 By Cohen Howard

The No Surprises Act (NSA) becomes effective on January 1, 2022 and will apply to virtually all commercial medical claims covered by ERISA, Non-ERISA, self-insured and fully insured plans for (1) emergency care performed by an out-of-network … [Read more...] about Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)

Filed Under: Surprise Bill

No Surprises Act Regulations Part I Released

July 6, 2021 By Cohen Howard

On July 1, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury issued part I of the regulations in connection with federal No Surprises Act that protects patients from surprise medical … [Read more...] about No Surprises Act Regulations Part I Released

Filed Under: News

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

June 29, 2021 By Cohen Howard

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

Filed Under: CH Case

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

June 22, 2021 By Cohen Howard

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

Filed Under: By Leslie Howard, CH Case

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

June 9, 2021 By Cohen Howard

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

Filed Under: CH Case

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

May 21, 2021 By Cohen Howard

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

Filed Under: By Leslie Howard

Will the No Surprises Act be Implemented as Lawmakers Intended?

May 13, 2021 By Cohen Howard

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?

Filed Under: News, Surprise Bill, Uncategorized

NY Lawmakers Reignite Single-Payor Bill

May 6, 2021 By Cohen Howard

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

Filed Under: News

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

April 21, 2021 By Cohen Howard

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

Filed Under: By Leslie Howard

Finding the Sweet Spot Under Surprise Bills

April 14, 2021 By Cohen Howard

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

Filed Under: Surprise Bill

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