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California Health & Safety Code §1371.4; 28 C.C.R. 1300.71 Health plans are required by California law to reimburse emergency providers directly for the reasonable and customary value of emergency services the provider rendered to the health plan’s insured member.

When it comes to appealing denied health care coverage, the biggest challenge may be the time and effort it requires to appeal a claim denial. The process can feel overwhelming and time constraints force medical providers into situations where they feel powerless or in many cases, forget to file.

Physi...

How to use Critical Care codes (99291-99292)

Critical Care is defined as an illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition and that the failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant or life threatening deterioration in the patient's condition.

This underused code set requires physician documentation of the time spent directly managing the unstable or potentially unstab...

Creditor overreaching and predatory lending are two common types of misconduct that constitute unfair lending practices.

Creditor Overreaching

Creditor overreaching typically occurs in one (or both) of the following ways:

  • the cost of a mortgage is substantially more than the benefit the borrower receives from the loan, and/or

  • the terms and benefits of the mortgage were misrepresented (or important disclosures were not provided) to the borrower.

Both types of overreaching may be present in a single transaction. If so, this can quickly lead for a foreclosure...

Seeking Full and Fair Payment for Providers

When a patient receives emergency room services, and the patient’s health care plan subsequently refuses to pay the entire bill, can the emergency service provider directly recover more from the same health care plan?  The answer is Yes. Doctors now have standing to sue in California for low reimbursement. 

Van Parys Law typically recovers 100% of the doctors’ billed charges. There is no fee unless you win. 

For physicians, the costs of running an independent practice is increasing while medical reimbursements are dec...

The relationship among providers, payors and other managed care  entities involves inevitable conflicts. Rising healthcare costs and an increasing pool of uninsured patients add pressure to already stressed relations between these entities, whether their interactions are defined by contract, statute or otherwise. Meanwhile, patients continue to demand access to their provider of choice, limiting the benefits of steerage. This paper provides an overview of the manifestation of these issues in litigation in recent months, and suggests some trends that those involved...

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