Managed Care Strategy & Disputes

Our Managed Care Team plays a unique and invaluable role in the healthcare industry. Many of the nation’s largest healthcare law firms represent managed care companies in disputes with providers. In contrast, Bass, Berry & Sims primarily focuses on representing hospitals and other providers in their dealings with managed care companies and other payors.

We represent the universe of healthcare providers, including hospitals and health systems, ambulatory surgery centers, air ambulance companies, dialysis companies, specialty pharmacies, clinical laboratories, physician practice management companies, and physician practice groups.

The passage of the Affordable Care Act has affected all stakeholders in the healthcare industry – patients, providers, and payors. Given the finite resources and infinite demands on the healthcare system, payors have become more aggressive by creating narrow networks, taking hard positions in contract negotiations, adopting restrictive claims handling policies and procedures, and raising premiums, all while lowering payments to providers. In this environment, it is critical to understand every aspect of the healthcare provider’s contractual and non-contractual relationships with managed care companies, as well as the laws that affect these relationships. Maintaining a viable business model may depend on having a clear understanding of these issues and a supporting business and legal strategy.

Invariably, disputes will arise. No matter the type of managed care dispute, we successfully navigate these disputes and aggressively negotiate, arbitrate, and litigate on our client’s behalf.

The scope of our Managed Care practice includes:

  • Contract strategy and negotiation
  • Public relations strategies for communications with patients, employers, physicians, and media
  • Contract interpretation and disputes
  • UCR disputes
  • Out-of-network strategies and disputes
  • Responses to attempted recoupments and offsets
  • Analysis of laws affecting managed care matters, such as ERISA, prompt pay laws, any willing provider laws, and the Affordable Care Act
Russell S. Baldwin
Counsel
Meg S. Casey
Senior Litigation Attorney
Michael Cottone
Associate
David R. Esquivel
Member
Courtney Ginn
Associate
Meri B. Gordon
Senior Litigation Attorney
Brian Irving
Associate
Charles G. Jarboe
Member
David A. King
Member
Sarah B. Miller
Associate
Sara K. Morgan
Associate
Lisa S. Rivera
Member
Lucas B. Salyers
Associate
Meredith Mallard Thompson
Counsel
Quyen Vo
Associate
Virginia Maynard Yetter
Associate

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