Insurers offered as little as $1.
Federal law won us six figures.
CoGenetix recovers underpaid and denied out-of-network surgical claims through federal arbitration, and runs your full revenue cycle, end to end.
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See exactly how we recover your money
Why this law exists, and why it protects the patient
For years, insurers underpaid surgeons and denied valid claims, sometimes offering as little as $1.00 on a six-figure operation. Congress passed the No Surprises Act so providers have a fair federal referee to make insurers pay, while shielding patients from surprise bills.
1 · Surgery performed
An out-of-network bariatric procedure (e.g., gastric bypass).
→2 · Insurer underpays
They pay a fraction of fair value, or deny it outright.
→3 · Federal arbitration
We take it to the federal IDR process under the law.
→4 · Fair payment
A binding determination, payable within 30 days.
✅ In-network = a deal was made
The provider and insurer agreed on prices, so the patient gets their lowest cost-sharing, a smaller deductible and a better split (say 80/20).
⚠️ Out-of-network = no deal
No agreed price. Normally the patient would face the worse rules, a bigger deductible and a steeper split (say 60/40).
💡 Why the big billed charge actually helps the patient
The provider bills a higher charge to the insurer, it's the starting point for fair payment, because insurers have underpaid for years. The patient is never responsible for it; they pay only their in-network cost-sharing. And here's the part that helps most: when the claim is paid fairly, that payment often satisfies, wipes out, the patient's deductible, so they owe little or nothing. The law protects the patient and gets the provider paid, exactly as Congress intended. (It's not just emergencies, it covers many non-emergency out-of-network services, including the bariatric / gastric bypass cases in this packet.)
Fair payment, faster cash
Determinations are binding and payable within 30 calendar days, and in practice we often see the cash land sooner. Depending on your fee schedule, awards frequently come in around 85% of billed charges.
New cash, fast
Awards are payable within 30 days of the determination, and in practice we often see payment land in as little as two weeks.
Often higher than expected
These surgical awards landed near 84% of billed charges, and depending on your fee schedule, can come in far higher than the insurer's first offer.
Patients protected
Patients pay only in-network cost-sharing, and a fairly-paid claim often wipes out their deductible entirely.
Surgical arbitration recoveries
Out-of-network bariatric surgery claims recovered through federal IDR, gastric bypass, sleeve gastrectomy, and hernia repair. Every dollar amount is shown exactly as received; identifying details are redacted.
| Payer | Code | Procedure | Billed | Recovered | Pt. owes | % billed |
|---|---|---|---|---|---|---|
| UHC / UMR | 43281 | Paraesophageal hernia repair | $118,230.00 | $97,439.64 | $0.00 | 82% |
| BCBS Texas | 43281 | Paraesophageal hernia repair | $118,230.35 | $100,126.65 | $0.00 | 85% |
| BCBS Texas | 43281 | Paraesophageal hernia repair | $118,230.35 | $100,495.80 | $0.00 | 85% |
| BCBS Texas | 43775 | Sleeve gastrectomy | $89,689.50 | $76,236.08 | $0.00 | 85% |
| Aetna | 43644 | Gastric bypass (Roux-en-Y) | $89,244.00 | $75,735.55 | $24.37 | 85% |
| Aetna | 43775 | Sleeve gastrectomy | $89,689.50 | $75,662.28 | $573.80 | 84% |
| Total, 6 surgical claims | $623,313.70 | $525,696.00 | $598.17 | 84% | ||
All awards are legally binding under the Federal IDR Process pursuant to PHSA §2799A-1(c)(5), ERISA §716(c)(5), IRC §9816(c)(5), and FEHBA 5 U.S.C. §8902(p). The non-prevailing party owes payment within 30 calendar days of the determination. Confirming payer remark codes: N830 (No Surprise Billing protection) and N875 (final payment selected by a Federal Independent Dispute Resolution Entity). Insurers offered as little as $1.00 (47564) or no offer at all (43281), and the provider still prevailed in federal arbitration. Codes: 43644 gastric bypass · 43775 sleeve gastrectomy · 43281 hernia repair.
What the payer offered vs. what we won
Straight from the federal IDR determination letters.
Denials, at scale
The recoveries above are a fraction of the picture. We route hundreds of denied and underpaid claims through federal arbitration, and we know exactly how to package them for the best outcome.
Denials in the pipeline
We work denials by type, medical-necessity, out-of-network, bundling, and more, and send the eligible ones to arbitration.
Batched line items
We can batch up to 25 line items into a single dispute, multiple patients with the same payer, for efficiency.
Strong single cases
High-value or unique claims get filed as focused single-case disputes built to win.
One partner, end to end
We run the entire revenue cycle, charge capture and coding through claims, denials, appeals, and arbitration, and specialize in recovering the out-of-network dollars most billers leave behind.
Surgical Billing & Coding
Accurate operative coding and clean claims for bariatric and complex surgery.
Denial Management
We work denials and underpayments to the floor, nothing left on the table.
NSA / IDR Arbitration
Our specialty, federal Independent Dispute Resolution for out-of-network claims.
AI Medical Coding
Faster, more accurate code assignment, fewer errors, fewer denials.
AI Eligibility
Automated, real-time benefit and eligibility checks before the claim goes out.
AI Appeal Letters
Tailored, well-argued appeal letters generated in minutes, not days.
Are your payers actually paying you fairly?
Run your standard payment reports, or give us your NPI and Tax ID, and we analyze reimbursement by NPI, by Tax ID, by CPT code, and by payer to see whether each payer is paying at the Qualifying Payment Amount (QPA), and how that compares to Medicare. What we very often find: payments well below Medicare.
Let's find your money.
Send us your payment reports, or just your NPI and Tax ID, and we'll show you, no pressure, exactly what each payer owes versus what's fair.
Request a free payment review →