STOP PAYER SHENANIGANS

When we work on your denied claims appeals, we do so on a contingency basis, meaning you pay only if we are successful, and the fee is a percentage of what we recover.

GOVERNMENT PROGRAMS

Medicare, Medicaid, and VA

Appealing claims denied by Medicare, Medicaid and other government insurance plans is complicated. There are rules dating back to the 1960s with long legacies and changes. You can't be expected to know them all. 

You'll need help to do two things:

  • Appeal the claims currently unpaid, if possible
  • Set you on the right track going forward to mitigate future denials
MANAGED CARE

Managed Care Denials

Appealing claims denied by Managed Care Plans is complicated because there are state and federal rules for HMOs, different rules for PPOs, and still other rules for ASOs and TPA claims. Often providers unwittingly agree to contracts plagued with ambiguity.

Our health law specialist paralegals with decades of appeal experience will identify the root cause and fight for your rightful reimbursement and interest, as appropriate.

You'll benefit from our help to:

  • Appeal the claims currently unpaid according to your contracts
  • Check the processes in place to maximize legitimate payment compliance
  • Guide you in future contract analysis and renewals to mitigate future claims payment hassles
ERISA

Self-Insured Employer

Appealing claims denied by self-insured employers and labor union health and welfare benefit programs is complicated because there are additional federal laws that sometimes preempt state and federal rules for HMOs and insurance companies. Often providers unwittingly agree to contracts plagued with ambiguity and aren't trained how to fight these complicated denials, and lack standing to fight denials because they have not been appointed as the Authorized Representative.

Our health law specialist paralegals with decades of appeal experience will sort out the ERISA claims payment rules and fight for your rightful reimbursement and interest, as appropriate.

You'll benefit from our help to:

  • Appeal the claims directly with the employer or labor union
  • Ensure your processes to protect your ability to appeal these complicated claims
  • Escalate your appeals to the federal level for external review, if necessary
  • Identify health law attorneys to escalate your matter to bad faith proceedings, if necessary
INTERNATIONAL

International Claims

Appealing claims denied by private international health and travel assistance insurers and government programs is extremely complicated and time consuming. We leverage our knowledge of international health programs and connections to insurers, TPAs, and government authorities from the medical tourism work we do. 

Our health law specialist paralegals team up with our international consultants to sort out the reasons for the denials and determine the appropriate remedy to get you paid.

You'll benefit from our help to:

  • Navigate the international maze of complex international insurance and coverage rules
  • Travel to the country in question to protect your interest, if necessary
  • Identify international health law specialists to escalate your appeal through the international courts system, if necessary

Optimizing every area of revenue management!

From contract analysis to root cause analysis to drafting the appeal, to submitting for external review, we cover it all.

GET IN TOUCH...

To arrange a consultation or workshop for your team or association, please send us a message.