Gottlieb and Greenspan, LLC primarily represents healthcare providers in reimbursement disputes with commercial health insurance plans.
Our clients include physicians/surgeons, ambulatory surgery centers, hospital systems, home healthcare agencies, and medical billing companies among others.
In addition, we routinely advise our clients on streamlining reimbursement, compliance with state and federal regulations, and defending against insurance recoupment attempts.
FEDERAL AND STATE SURPRISE BILLING ARBITRATION
With the passage of the No Surprises Act, effective January 1, 2022, out-of-network providers in New Jersey and New York are now tasked with deciphering a tangled web of overlapping state and federal balance billing laws.
We are here to untangle that web and file your case in the proper forum. And our record is superb—we consistently win the vast majority of state and federal arbitrations with thousands of cases filed to date.
OUT-OF-NETWORK ERISA LITIGATION
Because most health insurance plans are employer-based, they are often governed by the federal law known as ERISA. This means that for many insurance disputes, the only way to properly fight an insurance underpayment or denial is through an ERISA lawsuit, involving many of the complexities that accompany federal litigation.
We do not shy away from that complexity—we embrace it. Our attorneys have filed and settled hundreds of ERISA actions. We continuously stay abreast of the latest and often meritless defenses utilized by carriers, and we employ creative solutions to bring your case to a resolution.
IN-NETWORK ARBITRATION AND LITIGATION
In-network providers are not immune from improper insurance denials and underpayments. As a “PAR” provider, you are a contractual partner with the carrier. Thus, any infringement on your bargained-for rights ought to be contested and we excel at doing just that.
Whether via arbitration pursuant to a clause in the contract, or general breach of contract litigation, we are uniquely qualified to resolve in-network payment disputes.
RECOUPMENT ACTIONS
Just because an insurance carrier says they overpaid you, that does not make it so. In our experience, most overpayment assertions are predicated on dubious grounds. We have a strong record of successfully disputing overpayment and recoupment efforts initiated by insurance carriers. In fact, we have often recovered additional money for our clients in cases where the carriers originally sought recoupment.
MEDICAL BILLING COMPLIANCE AND GUIDANCE
In addition to the myriad regulations that have governed the healthcare industry for decades, medical providers and billing companies are navigating a new era of balance-billing laws.
These laws and regulations vary depending on medical circumstances, date of service, and type of insurance plan, among other things. We guide our clients to confidently comply with these new and often confusing rules, and further provide expert guidance to maximize their reimbursement.