Non-participating or Out-of-Network healthcare providers are commonly at odds with private health plans and payors regarding their billing, coding, and reimbursements. Whether through pre-payment review audits or retrospective audits, health plans and their third party administrators commonly interrupt providers revenue stream of reimbursements with claims payment delays and take backs.
Following several years of intensive litigation representing a host of health care providers, facilities, and doctors against:
CIGNA;
UNITED/OPTUM;
BLUE CROSS & BLUE SHIELD OF FLORIDA;
BLUE CROSS & BLUE SHIELD ENTITIES ACROSS THE NATION;
BLUE CROSS CALIFORNIA;
AETNA; and
many others
Anthony S Hearn PA has developed strategies for getting health care providers paid, and protecting from take backs those reimbursements already paid.
If you are an out of network health care provider that has received correspondence or demand from a private health plan payor you should obtain legal counsel immediately as many of your rights and defenses rely on timely responses under state and federal statutes.
