Health Law Unpacked With Maria T. Santi

From Denial to Justice: Legal Steps to Take When Your Emergency Care Isn't Covered

Episode Summary
In this episode of From the Clinic to the Courtroom – Health Law Unpacked, host Kevin Rosenquist is joined by attorney Maria T. Santi, founder and managing partner of the Health and Medicine Law Firm. Together, they discuss the troubling reality of emergency room visit denials by insurance companies and what legal steps patients can take when their emergency care isn’t covered.
Maria explains how federal laws like the Emergency Medical Treatment and Labor Act (EMTALA) and the Affordable Care Act (ACA) are supposed to protect patients but don’t always guarantee insurance coverage. She shares real-life cases where insurers have denied life-saving emergency care, the legal recourse available, and the need for legislative reforms to prevent unfair denials.
Tune in to learn how insurance companies justify denials, what patients can do to fight back, and how the law can be improved to ensure fair treatment.
Timestamps
00:00 – Welcome to From the Clinic to the Courtroom – Health Law Unpacked
00:06 – Introduction to today’s topic: Insurance denials for emergency room visits
00:33 – Why emergency denials happen despite EMTALA protections
00:52 – Common reasons insurance companies deny emergency room claims
01:52 – Case study: A patient denied emergency care after a medically necessary cosmetic procedure
03:51 – How hospitals and insurers negotiate coverage behind the scenes
05:14 – The insurance denial process: How decisions are made
06:14 – Understanding EMTALA and ACA protections for emergency care
07:56 – How often emergency room denials are overturned
08:55 – The need for legal reforms to protect patients
10:50 – The power of the insurance lobby and its impact on legislative change
12:37 – How legal action can push insurance companies to cover claims
13:36 – The impact of the No Surprises Act on emergency billing disputes
14:07 – How Maria stays focused despite the frustration of dealing with systemic insurance issues
15:18 – Closing thoughts and where to connect with Maria T. Santi
About the Show
From the Clinic to the Courtroom – Health Law Unpacked is a podcast dedicated to exploring the legal side of healthcare. Hosted by Kevin Rosenquist and featuring attorney Maria T. Santi, each episode breaks down critical issues affecting patients, doctors, and healthcare institutions. From insurance disputes to regulatory changes, this show helps listeners navigate the complexities of health law with expert insight and real-world cases.

When Insurance Says No: How to Navigate Denials and Secure the Care You Need

Episode Summary
In this episode of From the Clinic to the Courtroom – Health Law Unpacked, host Kevin Rosenquist and attorney Maria T. Santi, founder and managing partner of the Health and Medicine Law Firm, dive into the complex issue of health insurance denials. They discuss why insurance companies reject claims, the legal rights of patients, and the step-by-step process for appealing a denial. Maria provides valuable insights into navigating the appeals process, working with doctors, and when legal action might be necessary. She also sheds light on the role of  in claim denials and the challenges of transparency within the insurance industry.
If you've ever faced a denied claim and felt lost, this episode is a must-listen, offering practical steps to fight back and secure the care you need.
Timestamps
00:00 – Introduction – Welcome to From the Clinic to the Courtroom – Health Law Unpacked00:06 – Meet Maria T. Santi – Background on Maria and her firm’s mission00:35 – Why Insurance Denials Happen – Common reasons claims are rejected01:47 – Is It Just About Profits? – The financial motives behind denials02:21 – Patient Rights & Appeals Process – Steps to challenge a denial04:39 – Before Hiring an Attorney – What patients can do on their own05:28 – How Attorneys Fight Back – Maria’s approach to handling denied claims07:20 – Success Rates in Appeals – How often appeals overturn denials08:43 – AI in Insurance Decisions – The hidden role of AI in denials09:40 – Legal Strategies for Patients – Building a strong case against insurers10:47 – Do These Cases Go to Trial? – The legal pathways for patients12:35 – Mediation & Arbitration – Alternative ways to resolve disputes13:25 – Advice for Patients – Resources and first steps if your claim is denied14:33 – Doctors as Advocates – How physicians can help in the appeals process16:10 – Final Thoughts & Takeaways – Why persistence is key in insurance battles16:29 – Closing Remarks – Connect with Maria and the team
About the Show
From the Clinic to the Courtroom – Health Law Unpacked is a podcast dedicated to unraveling the complexities of health law. Hosted by Kevin Rosenquist, with expert insights from attorney Maria T. Santi, each episode tackles critical legal issues in healthcare, offering practical advice for patients, providers, and industry professionals.
 

The Intersection of Medicine and Law: Protecting Patients in a Legal Framework

Episode Summary
In this episode of From the Clinic to the Courtroom: Health Law Unpacked, host Kevin Rosenquist sits down with attorney Maria T. Santi, founder and managing partner of the Health & Medicine Law Firm. Maria specializes in health insurance coverage denials, patient rights, medical bill negotiations, and legal actions to protect patients.
She shares her journey from aspiring pediatrician to health law attorney, inspired by personal experiences advocating for her family. Maria discusses common reasons for insurance denials, the rights patients often don’t realize they have, and the complex legal landscape of healthcare law. She also highlights a memorable case where she fought to secure life-saving medication for a young child.
Tune in to learn about how to navigate health insurance denials, patient rights, and the evolving legal challenges in healthcare.
Timestamps
[00:00] – Welcome to From the Clinic to the Courtroom: Health Law Unpacked[00:06] – Introduction to Maria T. Santi and her firm’s mission[00:40] – Overview of Maria’s legal practice: Health insurance denials, patient rights, and medical bill disputes[01:20] – Why do insurance companies deny coverage? (Medical necessity, exclusions, experimental treatments)[02:09] – Patients’ rights and the legal actions available after denials[02:29] – Maria’s journey into health law: From pre-med to law school and starting her own firm[05:08] – The role of compassion and advocacy in healthcare law[05:46] – Key patient rights (privacy, informed consent, medical records access)[07:46] – Why is health law so complex? (Federal, state, and administrative regulations)[09:38] – Staying updated with evolving healthcare laws[11:05] – A memorable case: Securing a $2M life-saving treatment for a child[12:23] – Working with healthcare providers, not against them[13:23] – Are insurance denials getting worse? The role of AI-driven claim denials[14:41] – The broken healthcare system and the frustration of insurance battles[15:35] – Closing thoughts and how to connect with Maria
About the Show
From the Clinic to the Courtroom: Health Law Unpacked is a podcast dedicated to exploring the intersection of healthcare and the law. Hosted by Kevin Rosenquist and featuring legal expert Maria T. Santi, this podcast dives into patients' rights, healthcare litigation, medical insurance disputes, and the evolving legal challenges in the medical field.
Whether you're a patient, caregiver, healthcare provider, or legal professional, this show provides valuable insights on navigating the complex healthcare system and advocating for your rights.