We are excited to announce a major win secured by Jones Jones  LLC Attorney Christine Diana.  This win highlights:

  • The importance of reviewing all medical bills and location of treatment in order to determine proper payment of medical bill; 
  • The successful jurisdictional arguments Jones Jones LLC has brought as it relates to New Jersey surgical centers attempting to assert a “usual and customary” review of medical bills; and
  • The skillful litigation tactics utilized by the New Jersey attorneys of Jones Jones LLC in order to bring about a successful resolution of your medical bill disputes. 

 

Attorney Christine Diana recently litigated a New Jersey medical provider claim, saving an insurance carrier client over $170,000.00 in medical bill costs.

In most cases, a medical provider claim involves an injured worker with an established New York State Workers’ Compensation claim with treatment being rendered out of state, in this case, New Jersey. Doctors in New York State are bound by the New York State fee schedule for bills; which oftentimes presents itself as much less costly in New York as opposed to higher bill cost for same services in New Jersey. New Jersey reviews medical bills through the “usual and customary” standard.

For this particular claim, the claimant lived, worked, and was injured in New York State.  Her only connection to New Jersey was that she underwent surgery in a New Jersey surgical center.  The surgical center took the position that the insurance carrier must pay the “usual and customary” amount for services; in this case a bill amounting to over $184,000.00.  Our carrier client paid $14,000 towards the medical bill as per the New York State fee schedule.  The surgical center brought a suit in the New Jersey Court System asserting that  New Jersey had jurisdiction over the issue of the medical bill.   Through Attorney Diana’s skillful litigation of the matter, she was able to secure a major win for the insurance carrier.   She argued that New Jersey had no jurisdiction over the medical bill as there is an established New York Workers’ Compensation claim and there was simply a lack of connection between the claimant and New Jersey.

Ultimately, the New Jersey Court dismissed with prejudice the New Jersey surgical center’s argument that the carrier had to pay $184,000.00 in medical bills and the $14,000 payment per New York’s fee schedule was deemed appropriate.

Ensuring that medical bills processed by your team for review of expense and location of treatment is very important as oftentimes there are mitigation opportunities available to you.  The attorneys of Jones Jones LLC have seen the dispute of proper bill payment raised many times in the New Jersey Courts and are experts in arguing the proper payment of such medical costs.  The surgical and treatment centers in New Jersey continue to make the argument that New Jersey has jurisdiction over their bills despite clear case law that holds otherwise. The New Jersey attorneys at Jones Jones LLC  are excited to navigate you and your team through these jurisdictional issues in order to bring about medical cost savings.

Contact us at clientservices@jonesjonesllc.com today to set up a consultation.