Last year, Humble Surgery Center was involved in two major lawsuits in federal court in Texas that both dealt with out-of-network (OON) provider issues. In Cigna v. Humble Surgical Hospital, Humble won a major victory, but in Aetna v. Humble Surgical Hospital, Aetna walked away the winner. What happened, and what do these vastly different outcomes mean for OON providers and facilities today?
In this session, expert speaker Thomas J. Force, Esq. will closely examine both cases and offer advice for OON facilities on how to avoid adverse outcomes regarding balance billing, fee forgiveness and referral deals with physicians. Thomas will also outline strategies and techniques that will help you address insurance companies’ growing concerns about referral arrangements, balance billing and fee forgiveness by OON facilities. You will also be given a complete listing of essential policies and forms for your facility, and you’ll learn about current best practices for OONs. By examining a major OON facility and its experience in court with two insurance companies, Thomas will teach you how to properly set up an OON facility’s claims processing procedures and billing practices in light of these two important cases.
Who Should Attend:
- Jim Sheldon-Dean,
- Jill M. Young, CPC, CEDC, CIMC
- Jugna Shah and Valerie A. Rinkle, MPH, MPA
- Stanley Nachimson,
- Thomas J. Force, Esq.
- Joseph Wolfe,
Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general...
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