This was a 2013 case wherein the provider was able to obtain an in-network exception, but did not negotiate prior to surgery.  The complex surgery involved two co-surgeons and a physician assistant.  Billed charges totaled $412,176 for the co-surgeons, and $17,800 for the physician assistant.  The initial payment from the insurance company was $38,000 collectively for the co-surgeons and $1,680 for the physician assistant.  The provider filed a first level appeal before turning the case over

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In this 2013 case, patient had no out of network benefits through a self-insured policy.  The provider was able to obtain an in-network exception for the first stage of breast reconstruction.  After our client continued care with multiple surgeries, the insurance company refused to reimburse the client for her services. The appeals were exhausted by the provider. The Howard Group filed a pre-litigation demand and full amount of billed charges totaling $155,800.00 was ultimately

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This is a 2014 case wherein the provider was grossly under-reimbursed.  The billed charges were $28,500.00 and the insurance company paid $2,533.39.  The provider filed appeals, but did not receive any additional payments.  The file was then forwarded to The Howard Group at which point the appeals process had expired. Nevertheless, the group filed member appeals and ultimately received an additional payment for the provider in the amount of

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This is a 2014 case wherein the primary charges were $30,735.00.  The case was forwarded to The Howard Group after the provider’s claim was denied as “the authorization for the service was not approved”. The Howard Group appealed twice claiming that the provider did obtain authorization, as well as the fact that the doctor provided services to the patient who presented initially through the emergency room. The Howard Group obtained 90% of billed charges for

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