Matters
- Representing regional hospital system in private arbitration in multi-year out-of-network rate dispute with national payor
- Representing national hospital system in challenges to national payor’s new/planned payment policies
- Representing national air ambulance company in multiple putative class actions filed in federal district courts around the country in which patients are challenging the reasonableness of the company’s charges for emergency air ambulance services
- Representing regional hospital system in private arbitration challenging national payor’s attempt to apply new payment policies to contract
- Represented regional hospital system in multi-billion dollar contract renewal with national payor
- Represented a group of 21 Tennessee physicians in federal litigation in Nashville challenging a regulation from Centers for Medicare & Medicaid Services
- Represented a group of hospitals in arbitration against major commercial payor to establish rates for out-of-network claims for emergency services
- Represented several hospitals against a self-funded employee benefit plan for underpaying hundreds of claims contrary to the agreed fee schedule, with a focus on ERISA preemption issues
- Guided one of the largest nonprofit hospital systems in the country in developing an out-of-network reimbursement strategy
- Represented hospitals part of national system in a series of arbitrations around the country in disputes against a large commercial insurer for underpaying hundreds of claims related to medical necessity
- Represented several hospitals in a dispute against a large commercial insurer due to changes to coding policy in the provider manual contrary to underlying contracts
- Assisted a laboratory company in obtaining a network contract following years of medical necessity claim denials
- Represented a laboratory company against a large commercial insurer for several million dollars of claims denied for allegedly being investigational in nature
- Represented a laboratory company in pursuing several million dollars of unpaid claims because the insurer questioned the medical necessity based on allegedly ambiguous orders written by the treating physicians
