The Firm has been in business over 20 years and represents approximately thirty (30) health care providers
in Ohio, Pennsylvania, New York, Florida, Indiana, Michigan and Alabama. The firm also represents physician
providers and other medical professionals as well as individual patients who are having difficulties with
their insurance companies over reimbursement issues. These issues can include, but are not limited to: COBRA,
coordination of benefits, ERISA, Medicaid and Medicare or other governmental payers such as payment of prisoner
medical bills, as well as determinations of the medical necessity of the care the patient receives. Our firm
is involved once an insurance company, TPA or a self-insured plan, denies in full or in-part a medical bill.
Our attorneys will review the claim and determine the best course of action to induce the insurance company
to pay the legitimate claims of our clients the medical care providers.
Our services cover the gambit of legal services from simply writing to the insurance company to demand payment,
writing to the patient for COBRA or coordination of benefit information to litigation on behalf of our clients.
Some of our cases have been taken up to the Ohio Supreme Court or the Court of Appeals with success for our clients.
Our attorneys have set legal precedent in the area of medical reimbursement.
With governmental payers, such as Medicaid and Medicare, our attorneys have experience in the specific regulations
of these payers. Other governmental issues arise when a medical provider treats a prisoner and experiences difficulties
with having the governmental agency responsible for the prisoner, pay for the medical care provided.
Often insurance companies or TPA’s deny payment for medical care based on lack of medical necessity. One of our attorneys
is also a registered nurse and the medical necessity issues are reviewed by her who then proceeds to follow-up with the
payer to discuss their determination of the lack of medical necessity. Some of these cases are resolved through independent
medical reviews, litigation or discussions between our nurse-attorney and the payer.
Other issues our firm handles involve individual patients whose insurance company has denied coverage for medical care.
In the past we have assisted our clients with coverage issues for psychiatric care, ALS, COBRA and pre-existing issues.