Marketing and Empathy Psychology
Litigating Against the Out-of-Network Health Plan

By - Thomas J. Force, Esq.

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What every healthcare provider should know before litigating against an Out-of-Network Insurer

Overview:

Out of network providers frequently receive a higher volume of denials and audits from health insurers whose ultimate aim is to convince the out of network provider to join one of their networks where the reimbursement rates are significantly lower. As a result, many out of network providers face the real possibility of having to litigate with their patients’ health insurers to obtain proper reimbursement of claims for medical services. Most healthcare litigation must be conducted in federal court. Experienced litigators that understand federal ERISA laws and rules are few and far between and come with exorbitant hourly rates. This presentation aims to assist the out of network provider to make the difficult decision as to whether or not to litigate against a health insurer by providing the pros and cons of such litigation.

Webinar Goal:

  • Provide the benefits and perils of litigation by an out-of-network provider against a health insurer.
  • Arm the out-of-network provider with the necessary tools too make the decision to retain counsel to file litigation in federal court against a health insurer.

Agenda

  • Understand plan limitations that limit a possible damages award.
  • Review the contract document and reasons for its importance.
  • Explore compensatory and equitable damages.
  • Possible health plan counter-claims.
  • Discuss whether recovery could outweigh litigation costs.
  • The Time-Investment required when litigation is commenced.
  • Will Court simply remand action back to the administrator if the provider wins?
  • Importance of exhausting administrative remedies.
  • Regulatory Complaints.
  • Statutes of Limitations and Standing to Litigate/AOB/Anti-Assignment Clauses
  • Required patient forms.
  • Requirement that administrative remedies be exhausted.

Who Should Attend:

  • Healthcare providers and practitioners.
  • Healthcare attorneys.
  • Healthcare compliance consultants.
  • Healthcare revenue cycle personnel.
  • Practice office managers and billing staff.

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Speaker Detail

Thomas J. Force, Esq.

Thomas J. Force is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group. Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students. Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations. On March 29th, 2022, Thomas J. Force, J.D, Esq, President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section. For more information on this forum, please email Mr. Force.

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