New Hyde Park, NY asked in Health Care Law and Insurance Bad Faith for New York

Q: What type of payment would an attorney need for a NY balance billing case (2021 DOS), ie hourly?

What payment structure does an attorney use for a balance billing case in New York by an in-network provider?

In network provider balance billed me though insurance EOB shows $0 owed as their claim from 2021 was discounted to $0. Provider's billing company refused to resubmit their claim which was denied due to them not getting authorization. I contacted them by phone and email to make them aware the insurance company stated it's breach of contract as they are in-network. I have been sent to collections since then. Insurance company wouldn't help except except to tell the provider to contact provider services which I did with no change. I then asked about filing a complaint against the provider. I filed a complaint with NY State and no response yet. Provider billing company claimed they got authorization and told me to ask for it to be resubmitted but insurance company stated the provider needed to resubmit not the patient.

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY
  • Licensed in New York

A: Attorneys who handle medical billing disputes apply various fee arrangements, depending on the type of insurance (no-fault, private, etc.), volume of claims (in terms of whether it's a high-volume institutional client, such as a large medical office or single-transaction individuals), complexity of claims, and other possible factors. I've seen hourly arrangements applied (and on the collections end, hybrid arrangements involving interest).

The most reliable way to answer your question and find the best arrangement might be to make a few calls to various offices to ask about how they would handle your matter. Good luck

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