BCBS Massachusetts HMO Policy – Continuation Of Care

In this 2013 case, patient had no out of network benefits through a self-insured policy.  The provider was able to obtain an in-network exception for the first stage of breast reconstruction.  After our client continued care with multiple surgeries, the insurance company refused to reimburse the client for her services. The appeals were exhausted by the provider. CH Revenue Management Solutions filed a pre-litigation demand and full amount of billed charges totaling $155,800.00 was ultimately paid.

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