Maximizing Usual, Customary and Reasonable (UCR) Reimbursement

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Prompt Payment of Claims

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Recent Case Study

Eric Katz helps cancer patient give her surgeon a special gift...

Mr. Katz named to Best Lawyers in America since 2012.


Mr. Katz was voted a New Jersey Super Lawyer by his peers consecutively since 2007.

Mr Katz received this award due to his multiple million dollar settlements on behalf of his clients.

Mr. Katz is a Certified Civil Trial Attorney, a status held by only 2% of New Jersey attorneys.
Mr. Katz is one of only 3000 lawyers in the U.S. selected for this prestigious award.
   

Mr. Katz has recovered tens of millions of dollars for his healthcare and personal injury clients on a large variety of matters including managed care disputes over UCR determinations, prompt pay and third-party billing company negligence, automobile accidents, work place accidents, slips and falls, and product liability matters.  

Some of the larger, more recent, or unique recoveries are noted below:

$39 million class action settlement. Sutter v. Horizon Blue Cross Blue Shield Physician Class Action settlement. Under the settlement agreement, Horizon BCBSNJ has committed to implement significant business practice improvements related to physicians to increase transparency in payment of claims, reduce administrative overhead, and improve interactions between the health plan and physicians. These improvements will help enhance the efficiency and quality of the health care delivery system in New Jersey. Click here for article.

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$6 million settlement for a bus accident. This was a case involving a pedestrian who was run over by a school bus.  As a result of the bus accident, Mr. Katz’s client suffered severe spinal injuries.  The bus driver claimed that Mr. Katz’s client ran in front of the bus.   Through the efforts of Mr. Katz and the lawyers in his New Jersey law firm, we were able to get the bus driver to admit that she lied to the police and that she caused the accident.  The case settled for $6 million shortly before trial.  Click here for article.

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National class action settlement.  Kirsch and Jungels v. Delta Dental of New Jersey Dentist Class Action settlement. Under the settlement agreement, Delta Dental agreed to provide improvements and/or committed to retain a series of claims processing and provider relations practices that will significantly benefit not only dentists in the class but also persons to whom Delta Dental provides or administers dental benefits.  These business commitments will provide dentists more efficient access to information and assurance that designated claims processing procedures aimed at reducing administrative time and overhead in the claims submission and follow-up processes will remain in place for 5 years.  Click here for article.  Click here for article.

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Multi-million dollar dentist class action settlement, Kirsch v. Horizon Blue Cross Blue Shield. Under the settlement, Horizon BCBSNJ agreed to pay up to $2.85 million to class members and committed to implement significant business practice improvements related to dentists to increase transparency in payment of claims, reduce administrative overhead, and improve interactions between the health plan and dentists. These improvements will help enhance the efficiency and quality of the health care delivery system in New Jersey. Click here for article.

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$1 million settlement for slip and fall in a store. This was a case involving a woman who was struck by a hand truck operated by an employee of a store.  As a result of the accident, Mr. Katz’s client was knocked down and suffered a severe shoulder injury including RSD.  Through the efforts of Mr. Katz, the case settled for $1 million on the eve of trial.

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$1 million settlement for slip and fall in a store. This was a case involving a woman who was struck by a hand truck operated by an employee of a store.  As a result of the accident, Mr. Katz’s client was knocked down and suffered a severe shoulder injury including RSD.  Through the efforts of Mr. Katz, the case settled for $1 million on the eve of trial.

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$550,000 settlement for work place injury. This was a case involving a dump truck driver who was injured when he fell from the top of his truck while attempting to place a tarp over the load he was carrying.  Through the efforts of Mr. Katz, we were able to establish that the employer had a policy of intentionally overloading its trucks thereby placing drivers at risk.  As a result of the accident, our client suffered a back injury that ended his driving career.

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Confidential settlement of bad faith claim.   Under the settlement agreement, a PIP insurer paid a neurosurgical practice on claims wrongfully denied. 

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$375,000- Prompt pay and UCR settlement with major commercial health insurers of unpaid and underpaid emergency services claims submitted by non-participating neurosurgical practice and spinal surgical practice.

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$325,000- UCR settlement with major commercial health insurer of unpaid emergency services claims submitted by non-participating neurosurgical practice

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$318,243- Prompt pay and UCR settlement with major commercial health insurers of unpaid and underpaid claims submitted by non-participating neurosurgical practice.

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$317,000- Prompt pay and UCR settlement with major commercial health insurer of unpaid and underpaid claims submitted by non-participating neurosurgical practice.

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$300,000- Confidential settlement on behalf of network dermatologist against major commercial carrier of unpaid and pended claims.

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$293,000- Confidential settlement with major commercial carrier of claims improperly processed under New Jersey prompt pay laws.

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$275,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating neurosurgical practice.

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$235,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating neurosurgical practice.

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$220,000- Settlement of breach of contract and fraud action brought by a pediatric practice against a third-party billing company for failing to undertake appropriate follow-up with insurance companies on unpaid and improperly paid claims.

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$215,000- Confidential settlement with major commercial carrier of claims underpaid as a result of improper bundling and downcoding.

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$200,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating neurosurgical practice.

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$190,400- Settlement with Employee Welfare Fund of unpaid claims submitted by a neurosurgical practice.

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$180,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating spinal surgical practice.

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$175,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating spinal surgical practice.

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$125,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating orthopedic surgical practice.

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$115,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating orthopedic surgical practice.

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$60,000- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating neurosurgical practice.

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$48,750- UCR settlement with major commercial health insurer of underpaid claims submitted by non-participating neurosurgical practice.

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$20,000- Settlement of breach of contract claims against major class action claims recovery service company for failing to assist medical practice in gathering and submitting documentation and proof of claim form to settlement administrator in order to maximize recovery from physician/managed care class action settlement.

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Results may vary depending on your particular facts and legal circumstances. Because every case is different, the descriptions of awards and cases previously handled are not meant to be a guarantee of success.

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