MEDICAL BILLING LAW
HAKAKIAN WILLIAMS LAW GROUP PC represents healthcare providers in reimbursement, claims, and medical-billing disputes. These matters often arise after a provider delivers medically necessary care but the health plan denies the claim, pays less than expected, requests repayment, or applies a rule the provider believes is inconsistent with the plan or governing law.
COMMON PROVIDER DISPUTES
• Denied or underpaid out-of-network claims
• Medical-necessity, authorization, coding, bundling, and downcoding disputes
• ERISA benefit claims and administrative appeals
• Recoupment demands, audits, and overpayment allegations
• Emergency-services and No Surprises Act payment disputes
• Residential-treatment, mental-health, and substance-use reimbursement
• Contract-rate, usual-and-customary-rate, and network-status disputes
HOW THE PROCESS GENERALLY WORKS
The correct path depends on the patient’s plan, the provider’s contract status, the service, and the reason for denial. ERISA-covered plans must maintain claims and appeal procedures. For certain services covered by the federal No Surprises Act, an out-of-network payment dispute may proceed through open negotiation and, when applicable, federal independent dispute resolution. Other disputes may be governed by California law, a provider agreement, or the plan’s administrative process.
WHAT PROVIDERS SHOULD PRESERVE
Keep claim forms, EOBs and ERAs, authorizations, medical records, plan documents, contracts, fee schedules, correspondence, appeal submissions, and proof of timely filing. Deadlines for appeals, grievances, repayment responses, and dispute-resolution procedures can be short.
This overview is general information, not legal advice. Coverage, remedies, and deadlines vary by plan and claim.
