what we've done lately.
After commencing arbitration, sb2 recovers $1.6 mm from MCO for two of client’s behavioral healthcare facilities.
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sb2 successfully fends off MCO’s attempt to unilaterally change daily rate for skilled nursing care, saving client approximately $11,000 per day.
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sb2 uses proprietary strategy to recover $917,194.00 from MCO for long time client.
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sb2 uses CMS assistance regulation to overturn Denial and obtain retroactive Medicaid benefits for resident.
05/12/2023
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ALJ agrees with sb2 that resident couldn’t fund QIT because pension benefits were unavailable, directing county to redetermine Medicaid eligibility effective date.
05/10/2023
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sb2 appeals denial of current resident’s Medicaid application secures eligibility back to April ’22.
05/03/2023
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sb2 appeals penalty period for current resident’s transfers of assets and secures 90% reduction of Medicaid ineligibility period.
04/27/2023
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sb2 pushes MCO to reopen and process $200k in claim denials going back years related to single case agreements.
04/25/2023
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In a significant decision, ALJ ignores that resident no longer met level of care because MCO failed to provide resident with care planning services prior to abruptly disenrolling her from plan.
04/17/2023
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Board of Review agrees that county’s failure to process Medicaid application filed in ’19 means that it’s still alive today.
04/13/2023
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Hearing Officer agrees with sb2’s constitutional arguments and directs caseworker to open denial and give resident more time to provide missing verifications to establish eligibility.
04/10/2023
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After taking over appeal of Medicaid denial for longtime client, sb2 unwinds $24k penalty/restricted period for current resident.
04/06/2023
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sb2 appeals denial of resident’s Medicaid application and secures 12 months of retroactive Medicaid coverage after recovering misused long-term care insurance payments.
04/03/2023
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sb2 walks longtime client through difficult Medicaid appeal ending with $80k recovery.
03/27/2023
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