Out-of-network billing disputes can quickly escalate into high-stakes financial conflicts between healthcare providers and insurance companies. Physicians, surgery centers, and hospitals often find themselves underpaid, denied, or delayed when insurers refuse to reimburse for services provided to patients outside their network. These disputes can involve millions of dollars in revenue and pose significant compliance risks if not handled properly.
At Di Pietro Partners, our healthcare attorneys represent licensed medical professionals, practices, and healthcare entities in complex out-of-network billing disputes.
Please note: Our firm exclusively represents licensed medical professionals, group practices, hospitals, and healthcare entities in out-of-network billing disputes. We do not handle cases for individual patients seeking coverage for personal medical expenses or insurance benefits.
Common Issues in Out-of-Network Disputes
We assist Florida healthcare providers with:
- Underpayment or Nonpayment – insurers paying significantly below billed charges.
- Medical Necessity Denials – payors denying coverage for “unnecessary” services.
- UCR Challenges – disputes over “usual, customary, and reasonable” rate determinations.
- Balance Billing Conflicts – navigating Florida’s balance billing restrictions.
- Emergency Services – reimbursement disputes for out-of-network ER care.
- Delayed Payments – insurers failing to meet Florida’s prompt-pay statutes.
Why Choose Di Pietro Partners for Out-of-Network Billing Disputes
- Healthcare Law Expertise – We exclusively represent licensed providers, not insurers or patients, with a deep focus on Florida healthcare law.
- Proven Litigation Experience – Our attorneys are prepared to escalate disputes beyond negotiation when insurers refuse fair reimbursement.
- Medical Advisor On Staff – With a quadruple board-certified physician on our team, we bring both legal and clinical insight to reimbursement disputes.
- Statewide Representation When Needed – Based in Fort Lauderdale, we regularly represent physicians, surgery centers, and healthcare groups throughout Miami-Dade, Broward, and Palm Beach counties. While our strongest presence is in South Florida, we also take on select, high-stakes reimbursement cases across the state of Florida.
Federal & State Regulations
Out-of-network billing disputes often overlap with evolving regulations, including:
- The No Surprises Act (NSA) – federal protections for patients against certain out-of-network charges.
- Florida Prompt-Pay Law – requiring timely payments from insurers.
- State Balance Billing Rules – restrictions on billing patients directly in emergencies or HMO situations.
Our attorneys help providers comply with these laws while aggressively pursuing the payments they are owed.
Our Approach
At Di Pietro Partners, we combine legal, regulatory, and medical insight to:
- Review provider contracts and policy terms.
- Challenge insurer underpayment methodologies.
- File appeals and represent providers before regulatory agencies.
- Negotiate favorable settlements when possible.
- Litigate in court when insurers refuse fair reimbursement.
Frequently Asked Questions
- Q. Can providers still balance bill patients in Florida?
It depends. Florida law restricts balance billing in emergency care and HMO settings. Providers should seek legal guidance before billing patients directly. - Q. How does the No Surprises Act impact providers?
The NSA limits out-of-network charges for certain services, especially emergencies, and establishes an independent dispute resolution (IDR) process. We help providers navigate these rules while maximizing reimbursement. - Q. Do I need an attorney for an out-of-network billing dispute?
While providers can attempt to resolve disputes directly with insurers, complex cases involving significant sums or regulatory issues almost always benefit from legal representation.
Schedule a Consultation
If your practice or facility is facing underpayments, denials, or disputes involving out-of-network billing, contact Di Pietro Partners today. Our experienced healthcare attorneys are here to protect your revenue and defend your rights under Florida and federal law.
