Payment Disputes with Commercial Payors

We are increasingly seeing commercial health insurers taking aggressive — sometimes illegal — positions with respect to claims being submitted by health care providers, and delaying or denying legitimate claims for services.  Many commercial insurers fail to follow not only their own procedures, but also fail to follow ERISA rules for claims processing with respect to the employer sponsored plans they administer, as well as state prompt pay rules.  Timely and aggressive challenges to these abusive claims handling practices by legal counsel can make a difference.

The attorneys at Nicholson & Eastin, LLP regularly represent health care providers in claims and payments disputes with insurance companies, Medicare, Medicaid and other payors. Whether it is a claims audit, prepayment review, or overpayment demand, our attorneys — including a certified professional coder — can offer the legal guidance and intervention to expedite or improve the outcome.

Occasionally our physicians and other health care providers clients have a payment dispute with an insurance company that reaches the point where litigation becomes necessary. If you have a payment matter or dispute that has reached the point litigation, or otherwise requires attorney intervention, please contact us to schedule a consultation.