In 2020, the federal government enacted the Surprise Billing Act, officially denoted as the No Surprises Act (the “Act”) in an effort to mediate surprise medical billing issues. The Act ingrains certain patient protections, price transparency stipulations, and establishes a federal independent dispute resolution (IDR) process. The federal IDR process has been structured to resolve payment disputes that may arise between insurers and healthcare providers. This information was brought forth in an article authored by Maynard Nexsen, and can be accessed here: Navigating the Surprise Billing Payment Dispute Process: Tri-Agencies Issue Proposed Rule.
The Act is specifically designed to address crisis situations where patients unexpectedly receive hefty medical bills for services that aren’t covered by their insurance. These situations typically arise in cases where the patient has received emergency or non-emergency services from out-of-network providers. By implementing and developing the IDR process at the federal level, the government aims to offer a constructive pathway to resolve payment disputes between healthcare providers and insurers, thereby offering increased financial security to patients.
As legal professionals closely associated with corporations and law firms, it’s essential to have a comprehensive understanding of regulations like No Surprises Act. The established IDR process could be an effective solution to manage complex insurance claim disputes, further contributing to a seamless healthcare payment process and improved patient-client relations.