Commercial Health Insurance Disputes

Zuckerman Spaeder has developed a trailblazing and nationally recognized practice focused on expanding provider and patient rights in their relationships with commercial health insurers. 

Drawing upon nearly three decades of experience—primarily involving Employee Retirement Income Security Act of 1974 (ERISA), a statute governing federal benefit plans—we are at the vanguard of an entirely new health insurance recovery legal practice. We have developed a collection of innovative legal theories that are central to the fight and have built strong relationships with the U.S. Department of Labor. We regularly handle disputes concerning wrongful denials, improperly accessed administrative fees, attacks on out-of-network services, reimbursement rates, and recoupments and offsets for supposedly overpaid claims.

Our clients include hospitals, doctors, ambulatory surgical centers, other health care providers, and their patients. Unified by a common objective, we leverage client data and employ our ERISA strategy to shift the balance of power back in the industry. These strategies are designed to avoid litigation. However, when litigation has been necessary, our attorneys have won cases that expanded provider and provider rights, delivering significant monetary wins for our clients and forcing insurers to reform their practices.

The legal press, including The American Lawyer, The National Law Journal, Law360, and others, frequently recognize our team for our leadership and success in this area of practice. Recently, clients have reflected to legal ranking publication Chambers USA that we are “a real leader in the space,” are “extremely competent, efficient, cordial and reliable," and “top-notch litigators able to come up with novel legal theories.”

Behavioral Health

Seeking ways to limit coverage for behavioral care, insurers frequently develop more restrictive internal coverage guidelines for mental health and substance abuse claims than those applied to surgical or medical care. In doing so, they almost certainly violate the Mental Health Parity and Addiction Equity Act.

Zuckerman Spaeder leads a coordinated national effort to restore true mental health parity in insurance coverage for patients and providers. Using innovative legal theories, we have won key cases and represent a number of classes of patients in obtaining the coverage they need for mental health and addiction recovery treatments.

Most recently, the firm won a landmark victory in a case challenging United Behavioral Health’s mental health and substance use level of care coverage guidelines. Former Congressman Patrick Kennedy, the sponsor of the federal mental health parity act, hailed the case as the “Brown v. Board of Education for the mental health movement,” and CNN identified it as “one of the most important and most thorough rulings ever issued against an insurance company, at the federal level, on mental health issues.”