Are You a Target of Repayment Demands?
Written by Dr. Nick Oberheiden   
Wednesday, June 04, 2014 05:15 PM

One member doctor took a stand against an insurance company's harassment and prevailed.  His attorney explains the issue.

Did you get reimbursed by an insurance company and later receive demand letters to return that money? Increasingly, insurance companies have become aggressive in denying reimbursements for procedures that are covered by the parties’ provider agreements, particularly with respect to chiropractic services.  In some cases, the insurers even go so far as to demand that chiropractors return money that the insurance companies correctly paid out months or even years previously.

Our client, a member doctor of the Texas Chiropractic Association, came to us for legal help after Aetna’s demands for repayment became unbearable.  He had received numerous letters and phone calls from Aetna’s attorneys demanding that he pay Aetna thousands of dollars in “reimbursements” for interferential stimulation treatments that the insurer claimed were not covered by their provider agreement.

“I was shocked to first get money and then be accused of unlawfully receiving this money,” says the client in the case. “When Aetna threatened to sue me, I called attorney Dr. Oberheiden.” Indeed, Aetna’s attorney repeatedly threatened our client with a lawsuit to “recoup” the money it claimed had been wrongfully paid.

We set the record straight and filed suit on our client’s behalf in the United States District Court for the Northern District of Texas, a federal court in Dallas. Our lawsuit alleged that this type of therapy was covered by the parties’ agreement, there were no overpayments by Aetna, and Aetna failed to provide the provider with the appeal process he was entitled to by law.   In fact, federal law requires that insurers take certain steps when they seek reimbursements of payments made to health care providers.  The second we entered the case, the threatening phone calls and letters that interrupted his business ceased. Rapidly, we were able to negotiate an agreement between our client and the insurer that completely resolved the issue to our client’s fullest satisfaction.

The truth is that Aetna and other insurance companies have faced lawsuits across the nation for their harassment and illegitimate tactics. The insurance companies hope to scare chiropractors and other health care professionals into agreeing to their illegitimate demands by intimidation, threatening lawsuits and the removal of healthcare providers from preferred status.  Chiropractors faced with these issues should know their legal rights. Sometimes you need to fight.   

If you face similar challenges, talk to us. Find more information at www.federal-lawyer.com or contact Attorney Dr. Nick Oberheiden at nick@federal-lawyer.com.  Dr. Oberheiden holds a Juris Doctor from UCLA School of Law; his practice is exclusively dedicated to federal law. Co-counsel Attorney Elizabeth Stepp holds a Juris Doctor from Yale Law School. The Oberheiden Law Group, PLLC is located at 5710 LBJ Freeway, Suite 120, in Dallas, Texas 75240.  Prior results do not guarantee a similar outcome. This note may constitute attorney advertising in some jurisdictions.