Medical Provider Handed Mixed Bag As It Partially Prevails Against Insurer

Mealey's (September 4, 2019, 1:38 PM EDT) -- TRENTON, N.J. — A health plan never explains why its Medicare-based reimbursement rate would permit it to deny claims for sterile supplies or anesthesia, a federal magistrate judge in New Jersey recommended Aug. 16 in granting a provider summary judgment on the issue while also partially granting a dueling motion by the provider (Montefiore Medical Center v. Local 272 Welfare Fund, et al., No. 17-10213, S.D. N.Y., 2019 U.S. Dist. LEXIS 140293)....