Legal Basis Denial Dilemma

In worker’s compensation cases, providers often encounter obstacles in the billing and collection process. Insurance companies may decline coverage due to certain legal aspects, citing reasons such as post-term claim or statute for filing an injury. This situation can lead to patients grappling with substantial medical costs while providers have outstanding claims paid.

A longtime software engineer at GreenTech Solutions had developed severe carpal tunnel syndrome, a condition characterized by numbness and tingling in the hands as a result of extensive, repetitive computer work. 

Despite the worker’s attorney providing evidence reporting the cause of injury, the employer administrator refused to pay for the services of our provider based on a legal technicality – the statute of limitations for filing a claim had expired.

To resolve the dispute, a PQME conducted their evaluation and the findings confirmed that the treatment provided was appropriate. The evaluation stated the injury was the result of the constant deskwork his job required since no previous record was found related that could hint at the cause being older than the claim reported. 

Common Denial ReasonsHandling legal technicalities, expired claims, and understanding statutes.Successfully overturned 93.5% of denials in a recent project.
Unique ExpertiseProficient in PQME evaluations.Achieved favorable outcomes in over 80% of PQME evaluations.
Negotiation SkillsExpertise in resolving disputed billing and collections.Maintained a 95% success rate in negotiating settlements.
Lien Collection SuccessSpecialized in collecting denied liens.Achieved a 90% success rate, ensuring clients get paid.
Legal TechnicalitiesIn-depth knowledge of labor codes and regulations.Navigated legal complexities with a 95% success rate.
Legal Denial Stats

Medical Lien Management utilized the PQME evaluation to support the medical reports our provider presented and justified the services prescribed to the injured worker. Using our doctor’s initial and progress reports, medical records, and RFA, we filed for immediate payment of our provider’s bill. Our experts used effective negotiation tactics to ensure the timely collection of the full payments owed.

Providers currently dealing with piled-up unpaid bills can obtain clarity on their next move. Being a professional Lien Management Company, we can help you with that. Feel free to contact us for any queries or to acquire our help in your collection case. 

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