Hundreds Of Thousands in Mounting Receivables With Insurer Recovered In Settlement On Denied Claims

On some occasions a health insurer will engage in what Mr. Quadrino calls a “shut-down”: all claims of a medical provider are denied, for seemingly mysterious or incorrect reasons. It appears that the tactic is designed to force a provider from taking any more patients who are insured or have claims administered by the insurer, resulting in savings of millions of dollars by the health insurer.

Health care attorneys or other lawyers would likely seek to get into issues of billing or coding or the propriety or medical necessity as to the claims, but Quadrino Law Group has a unique approach. Mr. Quadrino has developed a strategy for his clientele built around the insurer’s unlawful conduct, rather than a defensive approach of explaining how the client’s billing is correct. Only by pressing against and highlighting the insurer’s illegality can true leverage be obtained, in Mr Quadrino’s view.

In one recent case with a client facing a shut-down, Quadrino Law Group filed a federal lawsuit, exposing the insurance company’s illegal conduct and arguing that payment on all of the denied claims was due and payable in full, as a legal requirement, based upon the health insurer’s unlawful conduct.

Shortly after the filing of the lawsuit and after a conference with a federal judge, the health insurer reversed course and settled with QLG’s client for a fair sum on the denied claims. A deal was also struck to stop the shut-down so that the medical provider’s cash flow was restored.

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