Legal Services
Breach of contract
The Issue:
When clients are faced with a dispute concerning the myriad of issues regarding a breach of contract, there are several avenues they may turn to. These include negotiation between the parties, mediation of the dispute, private arbitration, and litigation.
Solution:
We will provide you with a consultation and a thorough analysis of the issues of your dispute and your options. At that point, you may choose the option that fits you best.
Breach of Contract Defense
The issue:
When faced with a breach of contract lawsuit, you need immediate representation to protect your legal rights.
Solution:
We will file the necessary legal papers and work with you to analyze your case to provide you with the optimum solution to the issues facing the defense of the action.
Healthcare ERISA disputes
The issue:
When faced with an under-reimbursement or denial by a commercial healthcare insurer, it is difficult for healthcare providers to understand, much less to challenge, these determinations, and to know whether the underlying plans are governed by ERISA, which have certain requirements.
Solution:
We have vast experience in ERISA. We can provide ERISA consultation regarding which healthcare plans are governed by ERISA, how to internally appeal ERISA plans, and should the appeals result in an adverse benefit determination, we can litigate the ERISA matter. We can also maintain as necessary a state and federal IDR.
IDR
The Issue
Certain post-2022 under-reimbursements or denials are now governed by the No Surprises Act, federal legislation that established an IDR process to determine payments to emergency providers and non-emergency providers performing services in in-network facilities.
Solution:
We can provide provide you with consultation on the IDR process and file your case under the No Surprises Act IDR. Depending on the type of case, you may also opt to file under the New York IDR process.
Appeals
The issue:
When faced with an appeal in state of federal court, you need an experienced practitioner.
Solution:
We have state and federal appellate experience in the New York appellate division, the federal courts of appeals, and the Supreme Court of the United States.
- Breach of contract
- Breach of contract defense
- Commercial business disputes, including consultation, litigation, arbitration, and mediation
- Healthcare insurance ERISA disputes, consultation, litigation, arbitration, and mediation
- Healthcare reimbursement under New York State and Federal IDR under No Surprises Act
- Medical necessity denials by commercial healthcare insurers
- Experimental and investigational denials by commercial healthcare insurers
- Negotiation and implementation of Participating Provider Agreements, Managed Care In-Network Agreements & Ancillary Provider Agreements
- Commercial healthcare fraud defense
- Commercial healthcare insurance internal investigations including insurers’ Special Investigations Unit audits
- Advice, consultation, and representation concerning commercial healthcare audits
- Consultation concerning Summary Plan
Descriptions (“SPDs”), Explanation of Benefits (EOBs”) and other plan documents - Consultation and evaluation of commercial healthcare reimbursement and next steps
- Healthcare antitrust litigation
- Appeals in state and federal courts
Robert J. Axelrod
Senior Partner
Admitted to practice:
New York
U.S. District Courts, Southern & Eastern Districts of New York
U.S. Court of Appeals, Second Circuit, Third Circuit, Eleventh Circuit
Supreme Court of the United States
Phone: 646-986-4444
Email: raxelrod39@gmail.com
MY PRACTICE
Robert J. Axelrod is Senior Partner of Axelrod LLP and an attorney with a national practice representing healthcare providers and facilities in disputes with health insurance companies. He has over 25 years of experience in insurance litigation and deep knowledge of the Employee Retirement Income Security Act (ERISA) and related federal and state laws.
He practices healthcare law uniquely from the provider’s perspective. The reason is simple. Health insurers are represented by some of the largest and most powerful law firms in the country. While some law firms represent providers they also represent these same health insurers in disputes against providers. “I believe providers need and deserve legal representation entirely devoted to their interests and attorneys with a track record of standing up against the insurers’ lawyers and their often aggressive tactics.”
Practicing healthcare law from the provider’s perspective also determines my approach to client service. Each client deserves – and receives – my individual attention throughout the engagement. Most importantly, I see my role as resolving the dispute at hand and strengthening my client’s business in the process, rather than merely taking on a piece of litigation. While this sort of business partner may be rare within the legal community, I believe it is essential in assisting my clients.
KEY CASES
In re Blue Cross Blue Shield Antitrust Litigation, pending in the Northern District of Alabama, Master File No. 13-CV-20000-RDP, Chair of the written submissions committee for the provider track, decision denying in part motion to dismiss filed as Document No. 204, June 18, 2014.
Click here to read the document.
Addison v. American Medical Security, Inc. –prevailed as to liability after trial on behalf of a class consisting of people who purchased “Affinity Group” health insurance policies from American Medical, in the Circuit Court of Palm Beach County Florida, No. 00-01445 (AB) (Palm Beach Co. Fla. Cir. Ct. April 24, 2002).
Click here to read the document.
Blue Cross Blue Shield of R.I. v. Korsen, District of Rhode Island Civil Action No. 09-317L, 945 F. Supp. 2d 268 (D.R.I. 2013)
Click here to read the document.
Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, Northern District of Illinois Case No. 09-cv-05619 (MFK), finding in favor of PCA after trial and finding PCA entitled to permanent injunction, Document No. 912 Filed Mar. 28, 2014.
Click here to read the document.
Oxford Health Plans LLC v. Sutter, on brief to Supreme Court as co-counsel for Amici Curiae American Medical Association and the Medical Society of New Jersey, 569 U. S. ____ (2013)
LEGAL CAREER
Pomerantz LLP (1995-2014) Partner, (2002-2014)
EDUCATION
J.D., Brooklyn Law School, Executive Notes and Comments Editor, Brooklyn Law Review
M.A. History, Temple University
B.A., magna cum laude, History, Temple University
In Long Island Neurosurgical Associates, P.C. v. Highmark Blue Shield, the Court denied Highmark’s motion to dismiss this ERISA action based on an anti-assignment provision. In this case, Highmark relied on a provision in its Administrative Services Agreement (“ASA”) with a self-funded plan, not the Summary Plan Description (“SPD”). We argued, successfully, that because the ASA was not itself an ERISA plan document like a SPD it could not be used as the basis to challenge the assignment to the Plaintiff. The Court agreed.
Axelrod LLP successfully resolved an action concerning termination of insurance coverage.
Eleventh Circuit Court of Appeals affirms District Court decision holding that Blue Cross Blue Shield defendants are subject to per se standard of review in In Re: Blue Cross Blue Shield Antitrust Litigation (MDL 2406).
Court holds that Blue Cross Blue Shield defendants are subject to per se standard of review in In Re: Blue Cross Blue Shield Antitrust Litigation (MDL 2406).
