The Tennessee Medical Association (TMA) exists to support physicians and the practice of medicine across the state. This support takes the form of advocacy, education, networking and fighting for what members deserve. Recently, an all-in member group experienced a major win when they recovered thousands in recouped payments following the involvement of TMA.

Premier Surgical Associates reached out to TMA’s legal department with a problem that originated from treatment provided in 2023. Unexpected recoupments are always a headache, and this case turned out to be reversible. The following is an account from Premier Surgical Associates’ Revenue Director, Dawn Amato, of how the money was recovered.

“The patient who received treatment was covered by the United Healthcare (UHC) Marketplace Exchange plan. These claims paid about $30,000 in total with relatively no issues or major delay. However, in January 2026, UHC recouped ALL of their claim payments stating that the patient was not eligible all that time, and that he had Medicare. However, Medicare did not show him eligible during those dates. CBO team members tirelessly fought and appealed with UHC, but to no avail. UHC upheld their stance that they paid in error, that the recoupment was accurate, and that the law allowed this much time to pass between claim payment and clawback. (What a crock!) We were left with recoupments that occurred 21-24 months AFTER claim payment, nobody to file the claims to and the patient was not responsive.

As the Revenue Director, I got involved and made multiple calls to the Centers for Medicare and Medicaid Services (CMS) and Marketplace with no success at all. I then reached out to Yarnell Beatty with the TMA. Yarnell listened intently to my plight, understood the situation, shared perspective from a legal standpoint and agreed that the provider had been wronged in this issue. He assisted me in drafting a complaint to the Department of Insurance, but unfortunately that resulted in no help because UHC had proof that CMS told them the patient had Medicare. Yarnell then suggested that we go to our U.S. representatives who have jurisdiction over these governmental agencies. With Yarnell's help, I connected with Pat Gibson with Representative Tim Burchette's office. Through his assistance, he was able to get CMS to correct their communications to Marketplace, Marketplace to correct their communication to UHC, and UHC to reinstate the patient’s policy and reprocess the claims. I am now so happy to report that these claims were finally paid back to Premier Surgical Associates in July 2026!

I am so thankful for our partnership with TMA. This is not the first time they have assisted us with erroneous health insurance claim issues, nor do I expect it to be the last. I highly recommend every medical practice connect with TMA. They are a resource no practice should be without!”

TMA is humbled and honored to be a part of Premier Surgical Associate’s success story, and that wins like this are possible. Physicians work tirelessly to take care of Tennesseans, and TMA will make sure they are taken care of, which includes being paid.   

TMA can do this and much more for your practice or colleagues you know of that might be in similar situations. For assistance with payer issues like this one, reach out to legal@tnmed.org. To begin experiencing benefits such as these, start your membership journey today by joining at tnmed.org/join. For questions about group membership deals, reach out to TMA’s Director of Membership, Anjanette Eash, at anjanette.eash@tnmed.org.