Pathology Litigation
Montoya & Partners specializes in recovering unpaid and underpaid professional pathology services. In the State of Florida alone, the firm has recovered recovered over $150 million in past due billing to pathologists and has been responsible for over $100 million in go forward contracts with health insurance carriers. The Montoya & Partners team works directly with pathologists, practice managers, and billing companies to ensure efficient and speedy results.
Montoya & Partners represents pathologists in both individual litigation and class actions. Outside of the class action context, recent successes have also included several large settlements for individual groups against some of Florida’s largest commercial payors.
These settlements have resulted in significant payment on past denied and improperly paid claims, as well as favorable contract terms allowing each group to again go participate in network.
Class Action Lawsuits
In the firm’s pathology class action practice, from 2021 to 2023 alone, major class action settlements were reached for cases alleging the non-payment of the professional component of clinical pathology. These Defendants include:
- Sunshine State Health Plans, Inc.;
- UnitedHealth Care;
- Molina Insurance Co.;
- Oscar Insurance Company of Florida, Inc.; and,
- Centene/Ambetter.
Individual Cases
No two individual cases are alike, as each pathology practice has different considerations to deliberate.
The firm has successfully handled over 100 cases on an individual basis, with 100% of its individual case representations resulting in payment for past-billed charges and go-forward contracts.
These cases have resulted in over $70 Million in past-billed charges and over $100 Million in estimated go-forward contracts.
Arbitration
While many of its cases have been on behalf of non-participating provider pathology groups, Montoya & Partners has significant experience in arbitration litigation when a pathologist is contracted with an unperforming or underpaying health insurance provider.
Client-Service Understanding
The firm carefully screens client cases and consults with the primary points of contact within each practice, including but not limited to:
- Physicians: ensuring the practice owners or stake holders are aware of their rights and access to due process
- Practice Managers: integrating practice managers into the screening process, recognizing the integral role they play in medical practices; the firm works closely as with those heavily involved in contract negotiations and business decisions
- Medical Billers: working hand-in-hand with medical billers to best understand a physician group’s billing practices and methodology; with a comprehensive understanding of billing and coding processes, the firm ensures crucial billing data is collected
Opening the lines of communication and ensuring constant contact with all professionals helps the firm best serve the needs of all clients.
Beyond Litigation: Expertise & Services to Medical Professionals
Recognized as a trailblazer in the pathology field, Montoya & Partners is often called upon to advise physicians, practice managers, and medical billers on best practices for professional pathology services.
The firm’s attorneys routinely teach at the Florida Society of Pathologists’ Annual Convention and have presented to the California Society of Pathologists, in addition to numerous individual pathology groups across the country.
Contact us to learn more about our pathology seminars and to explore our upcoming availability.
WhyNow?
The COVID-19 pandemic, still fresh in everyone’s memory, has greatly improved the landscape of the firm’s litigation efforts. Judges and juries are now more sensitive to and better understand the need for timely, accurate, and reliable lab results.
Insurers, however, will unabashedly persist in not properly paying for the same. The fight continues.
With Montoya & Partners advocating for your recovery, you never have to fight alone.