Sorting out which dispute you have
Medical disputes tend to fall into a few recognizable kinds, and each runs through a different channel. Billing disputes, including surprise out-of-network bills, can often be challenged through the provider, your insurer, or dispute processes created by federal and New York law. Coverage denials usually start with the plan's internal appeal, and in New York many denials can then go to an external appeal through the Department of Financial Services. Concerns about the quality of care can be reported to the Department of Health or to professional licensing authorities, which can investigate but do not award money. A claim for compensation because care fell below accepted standards and caused harm is a malpractice matter with its own deadlines and requirements.
Paperwork that answers the first questions
Collect the bills, the explanation of benefits statements from your insurer, the denial letters, and any notices about appeal rights, since each usually states a deadline. If the dispute involves treatment, request your medical records through the provider's formal process; New York and federal law give you a right to them, subject to limited exceptions and reasonable copying charges. Note the names of the people you spoke with and when, and keep copies of everything you send. Paying a disputed bill just to stop collection calls is a decision to make carefully, since it can affect your later options.
Choosing the channel
Some medical disputes can be resolved well without a lawyer, and we will say so when that is the case. Others involve serious harm, large amounts, or an insurer that has not followed its own process, and legal help can change how they are handled. When you contact us, we sort out which kind of dispute you have, which deadlines are already running, and whether more than one channel should be used at once. If the matter may be a malpractice claim, we discuss what a medical review would involve before any decision to file.
