New York insurance law provides that charges by health service providers may not be greater than the schedules prepared by the workers’ compensation board.
Experience shows that reasonable people, and even experts, can differ on how to properly bill for many common health care services. Frequently, insurance carriers will pay a small portion of a bill and deny the rest, citing “fees not in accordance with fee schedules” on the denial form.
Fee schedule disputes may be resolved in arbitration or litigation by case law, expert testimony or by an independent health consultant when his opinion is requested by an arbitrator. We are aggressive in pursuing the maximum fees available to our clients based on the workers’ compensation fee schedules and the laws and regulations of New York. We invite you to ask us about some of the thorny fee-schedule cases in which we have prevailed.