Key Takeaway
Urban Well v Global Liberty: what the 2018 no-fault ruling actually decided about coding corrections, medical necessity and the unpaid balance.
This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
The insurer won this appeal. The decision does not establish a particular code substitution as a general billing rule. Urban Well Acupuncture v Global Liberty, 2018 NY Slip Op 51833(U), decided December 12, 2018, granted the insurer summary judgment except for an additional amount it conceded was payable.
Historical note: Urban Well resolves a particular motion record; for later service dates, consult the DFS schedule and effective-date guidance, including the October 2020 adoption affecting acupuncture reimbursement.
Last reviewed: September 2026.
What the court decided
The insurer supported two defenses: lack of medical necessity and charges exceeding the applicable fee schedule. Its reply corrected alleged coding errors and acknowledged an additional payment. The provider did not raise a factual issue requiring trial on the remaining dispute.
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The appeal also involved a renewed motion. A substantively identical report in proper form replaced an earlier unsworn chiropractor’s report. That procedural history matters; it is not permission to supply any missing proof on reply.
What this note does not establish
The opinion does not identify a change from CPT 97810 to 97811. Nor does it hold that every down-coded bill is proper. Code selection, permitted reimbursement and medical necessity are different questions. A useful review starts with the actual bill, treatment record, denial and calculation, rather than assuming the word “down-coding” answers them all.
The fee dispute does not authorize shifting an excessive charge to the patient. Insurance Law § 5108(c) prohibits requesting payment above the charges authorized by that section.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- OS Tigris: an unsupported fee-schedule defense.
- Great Wall: the November 2009 trial record.
- Great Wall: the split result in the August 2009 appeal.
- Live In Grace: the electrical-stimulation codes 97813 and 97814.
- Excel Surgery: New Jersey treatment and the service date.
- Healing Art: agreed coder testimony on codes 97810 and 97811.
- Precious Acupuncture: coder proof and post-2013 preclusion.
- Quality Comprehensive: fee proof supported only partial dismissal.
For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the bill, service dates, denial and payment calculation.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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Dec 26, 2017Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Q: Can my insurance company automatically reduce my medical bills without reviewing my case?
Urban Well does not decide the validity of automated review systems. It addresses the evidence supporting specific reductions and a medical-necessity defense; a reduction label alone does not establish the correct payment.
Q: What should I do if my doctor says the insurance company down-coded their bill?
Ask for the billed code, the substituted code if any, the payment explanation and the service date. Compare those documents with the treatment record before assuming the dispute concerns medical necessity.
Q: Am I responsible for paying the difference if my doctor’s bill is down-coded?
An insurer's reduction does not itself authorize balance billing. Insurance Law § 5108(c) prohibits providers from requesting payment above the charges authorized by that section.
Q: How can I tell if down-coding is affecting the quality of my medical care?
A payment dispute alone does not establish whether care was appropriate. Discuss treatment concerns with the treating clinician; this decision made no finding that a coding reduction impaired care.
Q: Can healthcare providers challenge down-coding decisions on behalf of patients?
This case was an action by a provider seeking assigned no-fault benefits. The correct claimant and available procedure depend on the assignment and dispute; the opinion does not prescribe a universal appeal route.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
