Medical Provider, Heal Thyself: Information on the Affordable Care Act

The moral of this biblical proverb is in its advice to attend to one’s own defects rather than criticizing defects in others.  Its relevance and practical applications are virtually without limit, for it can even be referenced in any situation or circumstance wherein an entity (whether corporate, individual, or other) bemoans the unfair treatment it feels it is receiving, but where that entity’s inaction or misguided effort enables the perpetuation of such mistreatment despite the availability of assistance that could affect a positive change.

What does this have to do with medical providers and facilities?  Plenty.

While the outworking of the Affordable Care Act continues, for better or worse, to define the economic impact to one-sixth of the U.S. economy – an impact which in a free enterprise system is felt on every level of a medical provider‘s ability to thrive and thus continue to offer the highest quality of care – the interposition of healthcare insurers in the doctor/patient relationship remains powerfully influential in determining what that quality of care will ultimately be.  Physician practices, like hospitals, are after all “for-profit” entities, and are largely dependent on receiving fair payment for the vital treatments they render.  That payment must pass through a for-profit insurer.  And therein lies a problem, both potentially and practically, if not inherently.

Even a cursory review of websites devoted to the bad faith payment practices of medical insurers can leave one’s head spinning.  The means utilized to achieve their end (which is quite simply, to increase their profits) are often the results of far more time, thought, and investment than the medical arena as a whole seems able to match.  Whether by implementing evermore obstructionist appeals processes, defaulting to payment schedules developed within the insurance community itself, or adopting computerized payment systems whose very appeal to the insurer is the cost savings promised by that system’s sales representative, the insurer has come to occupy the coveted high ground on the battlefield of reimbursement to medical providers.  Thus, they are winning that battle.  What’s a doctor, hospital, or surgery center to do?

First, know that it doesn’t have to be this way.  There are very powerful remedies available to the victims of insurer denial and short-pay practices.  Next, get connected with a law firm that cares enough to fight hard for the fullest extent of your rights and has done so with consistent effectiveness and with integrity.  Be very circumspect in your choice of that advocate, for there are many and their track records are as varied as their cultures and business models.  But regardless of whether or you choose to take these steps, consider this: Callagy Law has recovered over $140,000,000 in additional payments for our healthcare clients, including over 30,000 settlements and awards in the past five years alone.

This is a huge, and hugely significant, battle.  Fighting it alone is like taking on the Red Army with a BB gun.  Ultimately, you will get the representation and results that you insist on for yourself.  Just know that we are here to help you as well.  Contact us, and let the healing begin.

 

For more information please visit:

www.callagylaw.com

www.callagycounsel.com

 

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