Most physician practices do not realize the amount of funds from out-of-network billing that are never collected from a patient’s insurance company. Many have come to accept denial or under-reimbursement of out of network claims as ‘business as usual’ unable and unwilling to devote the time and effort required to fight back against the multi-billion dollar insurance industry. Practitioners continue to get either squeezed in or out of networks, and those that go in-network are accepting less and less for their services.
Payors make it extremely difficult for providers to challenge a denied or under reimbursed claim. The appeal process is lengthy, the insistence on various documents and proofs can be challenging to gather and responses to appeals leave results unchanged in most instances. Medical office staffing does not have the time or resources to focus on the level of detail required and the necessary follow up. Billing companies are established to ensure coding and proper billing occurs, and not necessarily to handle the time intensive requirements for appeals and challenges to payors.
At Cohen & Howard, we leverage on an underutilized area of the law, merging it with existing medical billing practices, our existing database of claim history and payments by carriers and our extensive knowledge of how ‘things work’ to greatly increase the recovery of out of network billings for our clients. Our staff is made up of attorneys, paralegals, medical billers, coders, and insurance industry insiders, to thoroughly analyze claims and create the arguments and strategies required to succeed.
We represent medical providers throughout the United States in securing additional payments under ERISA self- insured and fully insured plans and commercial claims under Federal and State employment benefit plans. A large part of our provider group clients consists of highly trained and skilled surgeons that have none or little participation in-network and desire to be compensated at fair and reasonable rates for their services. We handle all aspects of the medical reimbursement process from provider and member appeals, negotiations, arbitration, and challenges under Surprise bill laws. Our practice team works strictly on contingency so there is no legal fees paid by a client unless we are successful.