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Out-of-Network Reimbursement

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BRG has been retained in several cases relating to payments made by health insurers to providers that are not in their provider networks (out-of-network (OON) reimbursement). Our clients have included the nation’s largest health insurers, and issues have involved the reasonableness of payments to hospitals, physicians, and other providers.

BRG has been engaged by counsel for a large health insurer that is a defendant in a class-action matter involving the methodologies utilized by the insurer to price claims incurred by its subscribers for healthcare services that were performed by OON providers. Two BRG experts submitted expert reports that addressed reasons why the class should not be certified, as well as responses to the expert reports proffered by the plaintiffs on merits and damages. The reports were compiled using industry knowledge and experience, coupled with detailed analyses of the health insurer’s OON claims data.  

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