FPCA Automobile Division: West Palm Beach Doctor Prevails Over Humana In Small-Claims Court
Dec 29, 2009
The December 28 edition of The Miami Herald featured a story about Palm Beach dermatologist Dr. Steven Rosenberg’s successful small-claims court lawsuit against Humana for unpaid claims.
The referenced Miami Herald article is reprinted below.
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Palm Beach doctor has winning strategy for getting claim reimbursement
Patients aren’t the only ones who sometimes have problems with insurance. A doctor tried a novel approach to get the money he was owed, and he won.
BY JANE MUSGRAVE
Palm Beach Post
Miami Herald–December 28, 2009
Dr. Steven Rosenberg is a patient man.
But after waiting more than two years for Humana insurance to reimburse his West Palm Beach dermatology practice for roughly $120,000 in unpaid claims, he had had enough.
”It was like hitting our heads against the wall getting them to acknowledge our claims other than to say they were expediting the process,” said Rosenberg, president of the 21-doctor Palm Beach Dermatology and Pathology practice, which has offices throughout Palm Beach County.
Unwilling to pay an attorney up to 40 percent of the amount that was ultimately collected, Rosenberg decided to put down his medical journals and pick up some legal forms.
He took the insurance giant to small-claims court — the people’s court for disputes involving less than $5,000. Since most of the claims were under $200, Rosenberg bundled a few together to stay under the $5,000 limit.
”Where have you heard of someone suing for $5,000 and getting $80,000?” he said last week about the ongoing court fight he initiated in November.
As in many successful fights, the key element was surprise.
The North Miami attorney whom Humana hired to represent it ”had never been to small-claims court before,” Rosenberg said.
And, Rosenberg added, it was clear the University of Miami-educated lawyer didn’t want to spend much time there. He offered to settle.
Rosenberg accepted the offer but warned him that his time in small-claims court was far from over.
”This is the first of 25 claims we’ll be submitting,” he said. ”I told him Humana could save those $350 filing fees times 25 and his time and fees times 25 if they would just process our claims.”
The attorney seemed to accept the logic and promised to do what he could.
ONE AND DONE
Two days later, Rosenberg got a check for the first claim. Then, nothing. So, Rosenberg filed a second small-claims lawsuit.
Suddenly checks started arriving. In the past month, he estimates he has received about $80,000 in reimbursement from Humana and hopes the other $40,000 will arrive before the second case goes to trial in mid-January.
North Miami attorney George Wickhorst, who represents Humana, would not comment. Mitch Lubitz, a spokesman for Humana, offered this terse response: ”We are working to resolve the matter with Dr. Rosenberg.”
Doctors, who are all too familiar with Rosenberg’s financial dilemma, cheered his approach.
”It’s creative,” said Dr. Mark Rubenstein, a pain and rehabilitation specialist. ”It’s frustrating as a physician when you’re faced with denial of reimbursement when you believe you’re doing the right thing for your patients.”
STRATEGY GETS NOTICED
Even lawyers were impressed by Rosenberg’s tactic.
”It’s not a bad strategy. It’s a good way to get their attention,” said attorney Richard Benrubi, who often represents people in disputes with insurance companies.
While taking an insurer to small-claims court is unusual, he said a chiropractor he represented tried it several years ago. But the insurer successfully petitioned to move her small-claims cases to federal court, and then buried her in paper. She showed up in his office, asking him to sort it out. Rosenberg said Wickhorst and Humana have tried to legally outmaneuver him. So far, he said, it hasn’t worked.
While happy that he won his case and that the reimbursements have started coming in, he said he wants to be a doctor, not a lawyer.