Overview
Maynard Nexsen’s Managed Care Litigation Group provides legal services to multiple managed care companies, insurance companies, health plans, third- party administrators, and plan fiduciaries throughout the U.S.
Our attorneys have extensive experience with the managed care industry and have litigated and arbitrated the full spectrum of issues that arise in connection with health care plans and other payors of health care services. We have successfully fashioned innovative and bottom-line mechanisms for efficiently handling a wide array of payor-provider disputes, settlements, both informally and through alternative dispute resolution.
Our nationally-recognized expertise and substantial experience allow us to delve into the problems at hand and bring practical considerations to bear for our clients. Our managed care clients know that we will listen to their needs and objectives and collaborate with them to reach the desired result.
Maynard Nexsen is involved in managed care litigation from coast to coast and many of our attorneys are licensed to practice across the country, including in most U.S. Courts of Appeals and District Courts.
Our managed care team has represented clients in a broad range of suits and arbitration, including:
- Represented health plans in California Superior Court in proposed class action involving prescription drug benefits. Action dismissed prior to certification on summary judgment.
- Represented health plans on multiple occasions on issues surrounding health plans duty to pay medical providers "reasonable and customary" charges for emergency room treatment in a non-contractual environment.
- Represented health plans in multiple arbitrations involving claims by hospitals for reimbursement for “investigational” medical treatment.
- Represented health plan in several payor-provider California arbitrations where large hospital chains alleged that in excess of $10 million was owed under Preferred Provider Agreement. These cases were resolved for a fraction of the demand.
- Represented health plan in California arbitration where $3 million was claimed owed to hospital for stay in excess of two years. Claim resolved with no additional payment by health plan.
- Represented health plans in California arbitration where hospitals sought reimbursement for over $1 million in “off-label” prescription drug use. Claim resolved for a small fraction of demand.
- Represented health plans sued in superior court actions and successfully moved to compel private arbitration.
- Represented health plans in ERISA-governed actions against claims for Parity Act violations and medical necessity of mental health care services.
- Represented health plans in actions and arbitrations involving provider and hospital billing disputes over coordination of benefits, medical necessity and level of care issues.
- Represented health plans in state and federal courts and in arbitrations involving claims for statutory penalties under state prompt payment statutes.
- Represented health plans in connection with state and federal alternative dispute resolution claims asserted by out-of-network emergency physicians and facilities seeking additional payments on claims for emergency services.
- Represented health plans in resolving pre-litigation disputes and negotiations of contract amendments
- Represented health plans and ERISA plan administrators in coverage denial disputes
Some of Maynard Nexsen’s clients utilizing the Managed Care Litigation practice group include:
Blue Shield of California
Blue Cross Blue Shield of Alabama