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 to The Howard Group. The Howard Group was able to obtain an additional payment of $394,000 reflecting payment on all dates of service for this patient.