Rachel Roberson is an associate in the Health Care Litigation practice. She approaches the law through detailed analysis, thoughtful research, and deep respect for public policy. With a clinical background, Rachel regularly counsels business entities in the health care industries, specifically in provider-managed care disputes as well as surprise and balance billing.

Managed Care Strategy

Rachel guides healthcare providers and their vendors on managed care in-network and out-of-network strategies, including payor authorization and reimbursement practices, surprise and balance billing, federal and state legislation and implementing regulations, National Coverage Determination coverage requirements, and internal appeals and grievances processes for coverage and reimbursement.

Managed Care Disputes

She litigates numerous managed care matters, including managed care in-network and out-of-network underpayment disputes regarding DRG downgrades, payor pre- and post-payment audits, recoupments/offsets, unilateral payor policies, general claim denials–such as medical necessity, level of care, and authorization–and related legal issues involving the Affordable Care Act, the federal No Surprises Act, CMS Medicare and Provider Reimbursement Guidelines, EMTALA, prompt pay laws.

Alternative Dispute Resolution

On behalf of healthcare providers, she works to resolve managed care disputes through mediation or arbitrations with the American Arbitration Association, American Health Lawyers Association, and JAMS regarding coverage and reimbursement disputes with payors on a national level.