Blog

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 uncommon for insurance companies to make specific representations regarding a member’s insurance coverage, that are not honored after […]

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 final offer of $60,000 was a more fair and reasonable reimbursement for services rendered rather than the insurance company’s final […]

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 challenged United Healthcare’s (“United”) rate of reimbursement for services rendered to its members in the emergency room. The District Court found […]

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. Regardless of whether a patient’s policy is an EPO, HMO or PPO, out-of-network specialists performing complex surgeries, should be routinely requesting an […]

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 Protection, Transparency, Cost Containment and Accountability Act.  Since the Act went into effect August 30, 2018, Maximus has received 5,715 […]

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 year-end funding package. The latest proposal, ‘calls for parties to negotiate an agreed-upon rate […]

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 directed the Secretary of Health and Human Services, Alex Azar, to provide more public information on […]

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 taking this time for a staycation, instead they are hard at work helping their colleagues and […]

President Trump called upon Democrats and Republicans to pass legislation to end surprise medical billing in remarks delivered from the White House earlier this month.  Senators from both sides of the aisle have already been working on legislation for months to ban surprise medical bills. Surprise billing occurs when an out-of-network provider bills a patient for […]

Yesterday, NJ legislators passed Bill S-3202, sponsored by Senator Lagana and Senator Gopal, in a unanimous vote.  The bill requires hospitals to provide breast cancer patients with information concerning reconstructive surgery.  It also prohibits carriers from preventing the referral of a patient to an out-of-network surgeon who provides “the full scope of breast cancer reconstructive […]

Yesterday, a letter signed by America’s Health Insurance Plans (AHIP) and others asks Congress to take action this year to “pass legislation that will protect patients from surprise medical bills and reign in out-of-control health care cost.”  The letter outlines several steps to protect patients, most notably, requiring any legislation to encompass all health plans, […]

Today, Kaiser Health News published an insightful article on the Federal Surprise Bills being considered.  Federal legislation is likely to significantly expand patient protection, in states that already have surprise bills enacted, by including self-funded plans under ERISA and will provide much needed protection in states where surprise bills have yet to be enacted.  Details […]