Hospitals Turn to Us to Fight Back

Many hospitals do not really know the extent to which healthcare insurers deny claims because the insurer’s documents are impenetrable, and the denials come without reasoned explanations and documentary evidence.

The Issue: Each denial, including all those occurring in the past, up to the statute of limitations, must be appealed and, even then, the healthcare insurer will summarily deny a barebones appeal letter without accompanying evidentiary support. Even if hospitals were to attempt to perform all of this it in-house, it would require a substantial paid staff and take away from their core function of treating patients.

Our solution: We offer a unique solution. We do the work for you. We review electronic and paper payments and billing records through vendors in complete conformity with HIPAA. We next determine what has been denied, the bases for the denial, and the hospital’s legal options in challenging the denials.

We do all of this work without charge. We provide the client with a legal memorandum outlining their legal options, followed by recommendations as to the best way to pursue a recovery. The client’s retention of our firm to provide this legal memorandum without charge does not obligate them to retain us to perform any further legal work. If the client does decide to retain us to pursue a recovery, it will be covered in a separate Retainer Agreement.