Financial Settlement Obtained For Surgeon With Agreement That All Future Claims Practices To Comply With the Law

A large suburban county hired a regional claims administrator to handle millions of claims for the county each year. The administrator shut down all payments to our client, a surgeon, and issued denials that were not legally compliant because the Affordable Care Act now requires that the ERISA claims regulation’s rules be followed and incorporated into all plans, even government sponsored employer group plans.

We filed a lawsuit pursuing all of the clients’ rights to have all claims paid due to the late and unlawful claim denials. The county and its administrator first fought the case vigorously, claiming that all denials were proper.

We engaged in a series of settlement meetings in which we convinced the county and its administrator that the claims needed to be paid and that its claims handling was not compliant with the law.

Not only did we obtain a settlement in which all of our client’s claims were paid, but the county agreed to modify its future claims handling to comply with the law and that our client would no longer be subjected to an across the board shut-down on his patients’ claims.

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