Healthcare Law

The healthcare industry is subject to a maze of statutes and regulations. Providers, manufacturers, and distributors are subject to increased government scrutiny, making compliance an on-going challenge. We combine our intimate knowledge of the healthcare industry with our legal expertise to help you navigate the maze and achieve your goals.

While challenging to navigate, regulatory changes, such as the Accountable Care Act, have spurred innovation in healthcare, resulting in a plethora of healthcare-related startups. Yet, many founders struggle to understand the regulatory landscape. We welcome the opportunity to counsel startups as to if, when, and to what regulations they may be subject.

Healthcare-related areas in which PNW Strategic Legal Solutions provides guidance:

  • Disciplinary defense, including complaints, investigations, and audits such as those conducted by the Washington Department of Health (DOH), Medical Quality Assurance Commission (MQAC), Dental Quality Assurance Commission (DQAC), and mandatory reporting to the National Practitioner Data Bank (NPDB)
  • Compliance with federal and state healthcare regulations and law, including physician self-referral restrictions under Stark, Health Information Portability and Accountability Act (HIPAA), scope of practice under state law, and more
  • Comprehensive employment contract review, including non-competes
  • Payor reimbursement rate negotiation and contract review, including modeling
  • Review of healthcare startup plans for compliance
  • Appeal of medical claims denied by insurance companies

Healthcare Law For Patients

Medical Insurance Claim Denials

Has your medical insurance company denied a claim for benefits?  For certain types of treatments, doctors request advance authorization from your insurance company. Often, they bill your insurance company after treating you. Along with payment, the insurance company will send an Explanation of Benefits (EOB) to you and your doctor explaining what they paid, how much they paid, and reasons they denied payment. If the insurance company sends a letter refusing a request for advance authorization, or if they send an EOB denying part or all payment, that is an insurance denial. We help patients appeal those denials. Under the Affordable Care Act, patients can appeal a denial if the insurance company:
  • refuses to pay for part or all of a service that is a benefit under your plan
  • claims you are not eligible to enroll in the health plan
  • reduces or terminates a covered service that you have been receiving under your plan
  • claims the care is not medically necessary
  • claims the treatment is experimental or investigational
  • asserts you are not eligible for a certain benefit
A host of issues can lead to denials, ranging from the doctor’s office using an incorrect medical code to questions of whether the physician is in-network. We use our expertise to cut through the red tape to get you your benefits.

Time Limits

Claim denials must be appealed within a certain time period! So, contact us as soon as you receive a denial to allow us sufficient time to review your claim, gather needed documents, and craft a robust appeal.

Healthcare Law For Providers

Here is a sampling of the variety of healthcare-related areas in which PNW Strategic Legal Solutions provides guidance:
  • Disciplinary defense, including complaints, investigations, and audits such as those conducted by the Washington Department of Health (DOH), Medical Quality Assurance Commission (MQAC), Dental Quality Assurance Commission (DQAC), and mandatory reporting to the National Practitioner Data Bank (NPDB)
  • Practice purchase and sale
  • Compliance with federal and state healthcare regulations and law, including physician self-referral restrictions under Stark, Health Information Portability and Accountability Act (HIPAA), scope of practice under state law, and more
  • Comprehensive employment contract review, including non-competes
  • Payor reimbursement rate negotiation and contract review, including modeling
  • Review of healthcare startup plans for compliance

Thank you for helping me out of my health care coverage crisis and winning my case. Because of your intervention my future promises to be healthier and happier. You came to me highly recommended by a colleague for whom I have great respect and trust completely. You won my trust with your straightforward manner and my feeling that you had the expertise and experience to help me. You listened to my story and got to work without over-promising or needlessly vilifying. Immediately I felt you were on my side to solve this problem, that you would leave no stone unturned. I had been going it alone, while not in the best of health, and was under a lot of stress. Very quickly you turned things around and solved my problem! You also educated me in the basic matter of how to work with a lawyer and made it a point to go over our contract with just the right amount of detail, so that I could understand it. It impressed me that you really wanted to make sure I was following the procedure! I appreciated this because it was all new to me. You always answered my questions in a timely manner. Thank you again and feel free to share my wholehearted recommendation.

Y. D., December 2016

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Address:
1408 140th Pl. NE, Suite 170 Bellevue, WA 98007

Phone:
425-223-5710

Email:
info@pnwstrategiclegalsolutions.com

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