GET A FREE CONSULTATION

(877) 892-2797

Medical Prompt Pay Claim Recovery

The medical prompt payment claim attorneys at the Amaro Law Firm can help a variety of different health care providers obtain recovery under due to them under the Texas prompt Payment Statute and other applicable federal laws.  Sometimes, the amounts can exceed millions of dollars.  There may be potential recovery when the medical provider received untimely payment from third parties such as health insurance companies.

The law provides remedies for failure of insurance companies to promptly pay valid claims.  Although the remedy for each individual late payment may be small, these damage amounts can total millions of dollars when totaled over many years.  The Texas Prompt Payment Statute as well as applicable federal statutes provides for a variety of different remedies that the attorneys at the Amaro Law Firm can explain to you.

Some examples of medical providers which are protected by prompt payment statutes include hospitals, physicians, ambulatory surgery centers, doctors, medical groups, free standing emergency centers, diagnostic testing providers, clinics, and pharmacies.  The prompt payment lawyers at the Amaro Law Firm can provide medical providers with a way to document the late payments which are often received for 3rd parties such as insurance companies.

Carriers are subject to strict penalties for late payment of claims to contracted physicians and providers based on the number of days the payment is late.  As an example, if the carrier pays a clean claim between one and 45 days late, it must pay the full contracted rate of the services provided and either 50 percent of the difference between the billed charges and the applicable contracted rate or $100,000, whichever is less.

Also, if the insurance carrier pays a clean claim between 46 and 90 days late, it must pay the full contracted rate of the services provided plus either 100 percent of the difference between the billed charges and the applicable contracted rate or $200,000.00, whichever is less.  If the carrier pays a clean claim 91 or more days late, it must pay the full contracted rate of the services provided plus either 100 percent of the difference between the billed charges and the applicable contracted rate or $200,000, whichever is less, plus 18 percent annual interest on the penalty amount, accruing from the date payment was originally due and through the date of actual payment. Further, insurance carriers which violate the prompt payment law can also be liable for the underpayment of claims.

If you are a medical service provider that has been victimized by health insurance companies paying claims late in violation of the Texas Prompt Payment Statute or other federal laws, please contact one of the Amaro Law Firm’s experienced attorneys at 713-864-1941 or toll free at 1-877-892-2797.