Sauchik & Giyaur, P.C. (the "Firm") recently secured reversal of network terminations for five providers, ensuring that the providers continued as participating providers. The individual providers, who were part of the same practice, had received abrupt network termination notices from a prominent insurance plan.
The Firm, on behalf of the providers, objected to the terminations, demonstrating that they were not warranted. The Firm argued that the termination notices did not include any rationale for the terminations or a process for appealing the terminations, thus depriving the providers of their procedural rights under the New York Public Health Law. The Firm further argued that certain other matters, such as prior unresolved audits, were in fact the basis for the termination, but were pretextually excluded from the formal rationale for the termination.This was done in what appeared to be an attempt to eliminate consideration of valid objections that the providers had to the audit findings. The Firm also argued that the providers had been terminated in retaliation for advocating on behalf of their patients. Ultimately, the Firm made clear that the insurance plan did not provide an appropriate reason for terminating the provider agreements.
As a result of the unwavering efforts of the Firm, the provider agreements of these well-respected providers remained in place, and the insurance plan rescinded the termination notice. Providers and healthcare professionals, however, must be aware of similar pretextual terminations by health plans insurers, and must act quickly in response, as the timeframe for appealing terminations is often a short one. If you are a healthcare provider and find yourself in a similar situation, do not hesitate to contact our knowledgeable and experienced attorneys at 212-668-0200 or by email at firstname.lastname@example.org.