In the No Fault arbitration system, the legal burden to establish medical necessity rests unequivocally with the provider. For neurologists, this burden is uniquely technical, especially when seeking reimbursement for essential electrodiagnostic studies like electromyography (EMG) and nerve conduction velocity (NCV) testing. Your specialty involves correlating subjective patient symptoms with objective physiological data to diagnose complex conditions such as radiculopathy, peripheral neuropathy, and nerve injuries that are common in auto accident trauma.
Insurance carriers frequently challenge neurological claims by alleging that EMG/NCV testing is not medically necessary, is duplicative, or fails to prove a direct causal link to the accident. They rely on reports from non specialist reviewers who may not fully grasp the diagnostic value and technical precision of your testing, creating a significant barrier to payment for your critical diagnostic services.
Our Strategic Solution: Validating the Neurological Diagnostic Pathway
At Choudhry & Franzoni Law Group, we specialize in advocating for neurologists. We understand that proving the necessity of your care and testing requires constructing a precise, evidence based narrative. This narrative must connect the mechanism of injury to the patient’s symptom constellation, justify the need for objective electrodiagnostic correlation, and demonstrate how the findings directly informed the treatment plan.
Our legal team builds a formidable case by meticulously compiling a complete diagnostic record. This includes the initial neurological consultation detailing the history and physical exam, all relevant MRI or CT imaging reports, the complete raw data and interpretive report from your EMG/NCV study, and follow up notes showing how the test results guided subsequent care. We demonstrate that your testing was not merely exploratory but a specific, logical, and necessary step to objectively confirm a clinical suspicion of nerve injury.
Deconstructing No-Fault Denials Targeting Neurologists
When insurers deny your claims, we conduct a rigorous, science based defense of your clinical judgment and billing. Our analysis specifically targets the common denial tactics used against neurological providers:
Fee Schedule Denials
We challenge improper reductions or denials based on incorrect coding of EMG/NCV studies, such as bundling separate nerves or muscles incorrectly, or misapplying New York’s No Fault fee schedules for complex neurological testing and evaluations. We ensure you are reimbursed accurately for the technical and professional components of your specialized work.
Peer Review Denials
We systematically deconstruct reports from insurance retained physicians who question the necessity of your testing. We expose critical weaknesses such as the reviewer’s lack of specific training and board certification in neurology or electrodiagnostic medicine, their failure to address the specific clinical indicators that warranted the test, and their misunderstanding of the established guidelines for performing EMG/NCV studies in trauma cases.
Independent Medical Examination Denials
We aggressively counter denials based on biased IME reports that claim a lack of objective injury. We highlight the IME physician’s inability to replicate an EMG/NCV study’s objective data during a physical exam, the contradiction between their subjective opinion and your quantifiable electrophysiological findings, and the established medical principle that electrodiagnostic testing is the cornerstone for objectively confirming nerve pathology.
Causation Disputes for Neuropathic Conditions
We defend against allegations that findings of radiculopathy or neuropathy are degenerative and not traumatically induced. We marshal evidence from your report, such as the specific acute presentation, the correlation with new onset symptoms and corresponding imaging findings, and the absence of a documented pre accident history of identical neurological deficits, to establish a direct causal link to the accident.
Our Targeted Process for Neurology No Fault Arbitrations
Choudhry & Franzoni Law Group manages the entire legal and administrative burden, allowing you to focus on patient care. To build a definitive case for your practice, we will work with you to gather:
- Assignment of Benefits forms
- All insurance denial letters and Explanations of Benefits
- A complete billing ledger with CPT codes for the neurological evaluation and EMG/NCV testing
- Your detailed consultation and neurological exam notes
- The complete EMG/NCV report, including the raw data tracings when applicable
- All relevant imaging studies and reports
- Records from referring providers that establish the clinical question your testing addressed
- Any Independent Medical Examination or peer review reports from the insurer
Let Choudhry & Franzoni Law Group Handle Arbitration For Your Denials
From formal arbitration through to appeals, our firm serves as your dedicated legal partner. We are committed to ensuring you receive full compensation for the expert diagnostic care and objective testing you provide, which is often the key to unlocking a patient’s entire treatment pathway.
We understand the specific technical and causal challenges neurologists face in the No Fault system and provide assertive, detail-oriented representation to protect your practice’s revenue.
If your practice has provided necessary neurological evaluation or EMG/NCV testing following a car accident and has been met with unjustified delays or denials, you have the right to binding arbitration.
