Healthcare Provider & Ambulatory Surgery Center Rate Reimbursement
The High-Stakes Challenge
Commercial insurance payers systematically depressed, delayed, and under-reimbursed contracted fee schedules for independent ambulatory surgery centers and specialized physician networks.
Procedural Background & Motions
Insurers deployed complex administrative appeals and solvency defenses to delay millions in required healthcare reimbursement payments.
Our Legal Strategy
Pioneered innovative statutory litigation under the Texas Prompt Pay Clean Claims Act (Tex. Ins. Code §§ 843.338, 1301.103), challenged insurer calculation formulas, and defended practitioners in administrative and licensing board proceedings.
The Outcome & Results
Secured significantly higher contracted reimbursement rates, recovered delayed statutory funds with statutory interest, and protected physician licensure.
“Challenging institutional insurance payers requires deep mastery of both administrative solvency rules and statutory prompt-pay fee-shifting mechanics.”
Discuss a Similar High-Stakes Matter
Confidential case audit conducted directly by lead trial counsel.