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Gables Insurance Recovery, Inc. a/a/o Lazaro Enriquez v MGA Insurance Company, Inc.
GIR recently prevailed in Miami Dade Court against this carrier which had improperly breached its insurance policy as it pertained to the level of reimbursement to the medical provider. The carrier reimbursed the medical provider as per the Medicare Part B Fee Schedule and maintained that this was a “reasonable” fee. GIR successfully challenged the insurance company and secured a verdict entitling 100% of the amounts billed by the provider under the policy for which it was a third party beneficiary.
Gables Insurance Recovery, Inc. v United Health Care
GIR was successful in securing settlement with United Health on this claim for which the medical provider had provided the services to the patient/insured after carrier approval. United had ignored the submitted claim time and again and refused to issue payment for same. After engagement by the medical provider, GIR initiated legal action and litigated the matter to a successful result. United agreed to make payment for the fees due and outstanding.