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
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Ninth Circuit Court Holds ER Providers Have Independent Legal Claim Against 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 challenged United Healthcare’s (“United”) rate of … [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
Verify Changes to CPT Codes for Breast Reconstruction Claims
If your practice is experiencing an increase in denials or reimbursement delays from payors for breast reconstruction claims, it may be worth revisiting the CMS’s updates to the breast reconstruction codes that went into effect January 1, 2021. For a … [Read more...] about Verify Changes to CPT Codes for Breast Reconstruction Claims
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
Elective surgeries may have been ceased, but plastic surgeons are not resting amid coronavirus pandemic
During these unprecedented times, many elective surgeries have been suspended to allow for COVID-19 patients to receive necessary care in their time of need. This has halted most plastic surgeries for the time being, but plastic surgeons are not … [Read more...] about Elective surgeries may have been ceased, but plastic surgeons are not resting amid coronavirus pandemic
Reimbursement Benchmarks Will Exacerbate Surprise Billing Problem
On Friday, March 6th, Modern Healthcare published an article by Dr. William Jaquis, President of the American College of Emergency Physicians, discussing how narrow networks and high-deductible health plans are the true root causes of surprise bills. … [Read more...] about Reimbursement Benchmarks Will Exacerbate Surprise Billing Problem
Asbury Park Press Publishes Opinion Piece Championing Fair Payment for OON Providers
Out-of-Network Healthcare Providers Deserve Fair Reimbursement … [Read more...] about Asbury Park Press Publishes Opinion Piece Championing Fair Payment for OON Providers