The rulings in the cases, Cigna vs. Humble Hospital and Aetna vs. Humble Hospital, could be of significant benefit to OON providers seeking payment from plan administrators and defending against claims of overpayment.
Durham, NC (PRWEB) March 08, 2017
AudioEducator will host a Live Audio Conference presented by noted expert Thomas J. Force, Esq., titled “Reconciling Cigna vs. Humble Hospital with Aetna vs. Humble Hospital and its Impact on the Out-of-Network Provider,” on Thursday, March 16, 2017. This Conference will examine both cases and will discuss how the two insurance companies handled their referral scheme and OON billing practices.
Two recent Texas cases, “Cigna vs. Humble Hospital” and “Aetna vs. Humble Hospital,” address similar issues involving Humble Surgery Center with vastly differing outcomes. The court’s decisions in both these cases address a typical scenario for OON providers, that is, payors’ refusal to pay claims, which leads to catching all OON lawsuits seeking total overpayment refunds of claims, which have previously been paid to the providers; and all of this is based on broad and vague allegations of fraud.
The decisions in these cases are also a huge break for small physician groups and hospitals, who might not have the resources to fight a lawsuit against a health insurance company. Also, it means that it is obligatory for the providers to justify payment for the services that they render to patients irrespective of their participation status; and that a health insurance carrier should be able to prove that a provider has clearly violated the contracted guidelines before undertaking in a recoupment of payment.
In the live audio conference, Thomas J. Force, Esq. will examine both cases and will offer advice on how OON facilities can avoid an adverse outcome regarding balance billing, fee forgiveness, and other issues. The session will discuss the strategies and techniques to address the concerns of insurance companies about referral arrangements, balance billing, and fee forgiveness by OON facilities. The session will examine how a major OON facility and two insurance companies handled their referral scheme and OON billing practices. It will further discuss how to set up an OON facility and what policies an OON facility should have in place.
For more information visit: https://www.AudioEducator.com/hospitals-and-health-systems/aetna-humble-litigation-impact-on-oon-provider.html
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