It is estimated that insurance companies have wrongfully denied and delay payments of approximately $8 Billion dollars to Texas Medical Providers. These delayed and denied payments have allowed some insurance companies to make large profits at the expense of hard working medical providers. In response to these unethical insurance practices, Texas has enacted the Texas Prompt Payment Act that allows medical providers including hospitals, pharmacies, clinics, and physicians to seek payments and penalties from insurance companies that wrongfully deny and delay payments.
Texas Prompt Payment Lawyer, Jason S. Coomer, is a Texas business litigation lawyer that represents medical providers in seeking prompt payments from insurance companies. For more information on this topic, please contact Texas Prompt Payment Medical Provider Lawyer Jason Coomer via e-mail or use our online contact form.
Seeking Prompt Payment From Insurance Carriers
Insurance carriers that violate prompt pay laws and miss the deadlines for paying or responding to health care provider claims may be held liable for penalties for being late. For hospitals and physicians, the late penalties can begin within 45 days of receipt of a clean claim submitted non-electronically and within 30 days of receipt of a claim submitted electronically. For pharmacies, the late penalties can begin within 18 days of electronically submitted bills.
The penalties for late payments include a fifty percent (50%) penalty of the difference between the provider's billed rate versus its contracted rate if the payment is 1 to 45 days late and a one-hundred percent (100%) penalty of the difference if the payment is 46 to 90 days late. There are also provisions that allow an eighteen percent 18% late fee and attorneys fees to be collected on any late-paid bill.
Protection for Medical Providers From Retaliation
In the past, some medical providers have been reluctant to seek assistance in collecting payments from insurance companies because of potential retaliation that might occur. However, three statutory provisions protect Texas healthcare providers from retaliation by insurers or pharmacy benefit managers. These provisions include Tex. Ins. Code Section 843.281 and Section 1301.066 and 28 Tex. Admin. Code Section 11.901(a)(2).
Texas Business Lawyer and Texas Business Lawyers
Texas Business Lawyer, Jason Coomer handles business lawsuits and commercial litigation including real estate disputes, construction disputes, breach of contract claims, business fraud claims, partnership breakups and business dissolutions, shareholder claims, breach of duty claims, ownership & joint venture disputes, commercial development disputes, and intellectual property disputes. He represents clients through negotiations, arbitrations, mediations, and trials. He is an experienced litigator and is admitted to practice in all Texas State Courts and in Federal Court (Western District of Texas).
In coordinating efforts with other Texas Business Litigation Lawyers, Jason Coomer, is able to assist businesses throughout Texas. Through business litigation teams he has been able to protect clients from aggressive business litigation attorneys thereby protecting millions of dollars in assets as well as future profits for an investment group that owns a large commercial development. He has also be able to work with his business litigation teams to obtain large multimillion dollar recoveries.
If you need a Texas business litigation attorney for a Texas Prompt Payment Act or other business litigations, please feel free to contact Texas business litigation lawyer Jason Coomer.