Ever sue a commercial payer or call the state on them?

Have any of you ever had an issue with a private payer that got so bad you had to seek relief outside their system -- that is, through the law, or the insurance commissioner or some other agency?


Roy Edroso
Part B News


  • edited May 2017
    Many years ago, in Maryland when I worked with a group of physicians that were activists, the Insurance Commissioner invited us to their offices and wanted to speak with us in regards to how their office was used.

    The Insurance Commissioner (in Maryland) – is a consumer advocate, the department is not their for the grievances of physicians.

    Physicians are expected to go through their state medical society or specialty society when having problems with plans. If it is a contract issue, then an attorney is needed to help come to resolve.

    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219-0409

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com

  • edited May 2017

    I routinely report insurance carriers to the Department of Labor, EBSA division for illegally denying covered services, illegally recouping from physicians and hospitals and more, on ERISA claims. Of course, if it's an ERISA claim - which probably 80% of non Medicare and Non Medicaid claims are - then the state insurance commissioners and state laws are second to the federal ones or completely irrelevant. So far, I haven't had to take any of them to court, but I wouldn't hesitate to refer them to Jin Zhou who routinely does and kicks some butt. He may be hard to understand - but that guy is as tenacious as a buzzard waiting for a meal.

    Is this what you mean?


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

    DISCLAIMER: This email has not been scanned for correct spelling, grammar or punctuation. It has been created in the language of Texan and may or may not be understood completely to those north of Kentucky.

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