Health Law & HMO Liability

The term "Health Law" can cover a variety of legal, regulatory and contractual issues affecting the triangle of providers, patients, and insurance companies. At PCP&B, we focus almost exclusively on helping physicians and medical care providers assert their rights against HMOs, utilization review agents, and other managed care entities that would seek to deny physicians the right to be paid for their services. As health care providers are forced to navigate the constantly shifting minefield of claims processing procedures developed by the managed care industry to delay and deny payment, PCP&B remains committed to the task of developing new legal strategies to stay one step ahead of the managed care industry. In the process, we often find ourselves litigating issues of first impression, including the application of Article 21.21 of the Texas Insurance Code, the Texas Prompt Pay Act, and ERISA. At PCP&B, our track record speaks for itself. Over the last two years alone, our attorneys have recovered over $1.1 million dollars from HMOs in unpaid claims owing to health care providers.