One of NBWT’s areas of expertise is pursuing reimbursements owed to its healthcare provider clients. Zach Thomas and Scott Nichols have significant experience handling both in-network and out-of-network reimbursement claims under state law (breach of contract, violations of the Prompt Payment Act, violations of the Insurance Code) and federal law (ERISA plan benefits, ERISA civil penalties).
NBWT currently has suits or arbitrations on file for physician practice, ambulatory surgery center, freestanding ER, and lab clients in which it is seeking more than $105 million in unpaid reimbursements, Prompt Payment Act penalties and interest, and prejudgment interest. The firm pursues reimbursement claims on an hourly, contingency, or hybrid-contingency basis.
Below are just a few examples of the favorable settlements the firm secured for its clients in 2021:
- A foreign-based insurance company refused to pay and stopped taking a surgery practice’s Once NBWT got involved, the insurer settled for 86.8% of the practice’s billed charges for the emergency surgical services in question.
- For years, a physician practice got the runaround from a self-funded plan’s third-party administrator. NBWT sent a pre-suit demand letter. Before NBWT filed suit, the plan agreed to pay 100% of the demand.
- After NBWT filed suit, an insurer settled for 91.4% of the surgeon’s billed charges for emergency surgical services rendered to a foreign exchange student who was hit by a car more than three and a half years earlier. Before retaining NBWT, the surgeon had effectively given up on ever receiving proper reimbursement.
- NBWT filed suit against a self-funded plan that improperly used Medicare rates to calculate the “usual, customary and reasonable” rate for the ambulatory surgery center’s Once the plan was served, it immediately settled for 85.3% of the center’s billed charges (many times the Medicare fee schedule rates) without even filing an answer.
- After NBWT filed suit, a self-funded plan paid 50.8% of the surgery group’s billed charges for emergency surgical services to repair and stabilize the patient’s severe injuries. Before that, the plan and its third-party administrator sent only generic form appeal-denial letters to the group that did not comply with ERISA regulations.
- After NBWT filed suit, a self-funded plan settled for 50.8% of an ambulatory surgery center’s billed charges, even though the plan contended that the center’s claims were not properly appealed and were barred by an internal limitations period in the plan document.
- After NBWT filed suit, a self-funded plan agreed to settle for 50.2% of an ambulatory surgery center’s billed charges, despite asserting that the center’s claims were barred by an anti-assignment clause and internal limitations period in the plan.
“It feels great to achieve good results for our provider clients,” said NBWT’s Head of Litigation, Zach Thomas. “They work hard for their patients and deserve to be properly compensated for their efforts.”
