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.

 

If you would like more information regarding the specific facts of this case or article, please contact us
.