Our firm represents some of the largest hospitals and healthcare systems in the United States. We aggressively represent our Clients against Insurance Companies who wrongfully reduce or deny third party insurance payments required by statute or contract. As a business model, insurance companies are designed to evaluate risk to maximize profits, while minimizing losses. On the other hand, hospitals and healthcare systems are designed to help the needy and consist of governmental, non-profit and/or proprietary organizations. In order to be successful in accomplishing that mission, hospitals rely on our firm to ensure that third party insurance companies are properly paying their required legal medical reimbursements.
Personal Injury Protection ("PIP")
PIP has probably been one of the most litigious areas of insurance law in the United States. In an effort for the legislature to ensure "prompt and speedy" payment of medical bills to providers, Insurance companies have taken a biased approach to its interpretation. Rather than expediting payment, Insurance companies have taken a position of down-coding charges, reducing payments and even denying bills. Every PIP insurance company uses its own tactics, but they all result in the same conclusion: Reduced or denied payments for medical providers and more profit to the insurance companies' bottom-line. Automobile insurance companies recognize that large medical providers such as hospitals and healthcare systems are understaffed, overworked and cannot pay full attention to smaller portions of their billing such as PIP or Worker's Compensation claims. Unless medical providers have aggressive legal counsel to understand the nuances of the No-Fault Statutes, case law and legislative changes, they are leaving money on the operating table. Our firm aggressively and ethically pursues all of those insurance benefits for our Clients.
Workers' Compensation ("WC")
Most states have adapted an employer-friendly approach to dealing with Workers' compensation claims and reimbursement for payment. Once a Workers' compensation claim is approved, the WC carrier must reimburse the hospital, healthcare system or other medical provider a certain percentage of outpatient charges, a different percentage for in-patient charges as well as using fee schedules for certain supplies used to treat patients. With this clearly outlined in the state statutes, it should be fairly simple to properly pay medical providers right? Not always. Not only do some WC carries underpay the claims, but they also attempt to sign onto the umbrella of health insurance carriers to take advantage of "network reduction" discounts. Our firm determines reviews the accounts, reviews any alleged "network reductions" and recovers underpaid/denied claims against the WC insurance carrier for our Clients.
As Featured On: