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The No Surprises Act, Two Years On


It is rare to hear good news these days about the physical or financial health of the American public, or especially about the cost of healthcare, but a recent report by the Urban Institute offers an optimistic view of the No Surprises Act, which was signed into law in 2021 and went into effect at the beginning of 2022.  The report showed that the new law has substantially reduced the cost of emergency healthcare by limiting the amount that out-of-network providers can charge patients for services rendered on an emergency basis; consumer advocacy organizations have received far fewer complaints about surprise medical bills than they used to receive before the No Surprises Act went into effect.  The Urban Institute Report also showed that, despite some interruptions, the arbitration system for collecting payment seems to be working well, also it places a heavier workload on small healthcare businesses than large ones.  A Washington DC small business lawyer can help your healthcare business navigate the process of negotiating with insurance companies about out-of-network services.

What Does the No Surprises Act Do?

The No Surprises Act limits the amount of money that hospitals, physicians’ groups, labs, and other healthcare businesses can charge for emergency medical treatment.  When an insured patient visits a hospital emergency room, the ER physician, radiologist, and lab might not be in the patient’s insurance network.  Likewise, if a patient gets airlifted to a hospital, the patient’s insurance may or may not cover air ambulance services.  Pursuant to the No Surprises Act, the maximum amount that the providers can charge patients is the amount that an in-network provider would charge for the same services.

The No Surprises Act also establishes an arbitration process, known as Independent Dispute Resolution (IDR), through which the doctor and the insurance company negotiate about how much the patient’s insurance company will pay for the charges that, were it not for the No Surprises Act, would be the patient’s responsibility.

How Small, Private Practice Healthcare Providers Can Deal With Independent Dispute Resolution

Collecting payment through IDR is no more difficult than spending a few months badgering patients about bills that everyone knows they can’t pay and then selling the unpaid debt to a collection agency for pennies on the dollar.  It is considerably more work for small doctors’ offices, where the billing staff is only one or two people, than it is for large hospitals and physicians’ groups.

IDR is certainly fairer to patients than holding them responsible for medical bills they never expected and can never pay, but in arbitration, bigger companies always have an advantage over individuals and small businesses.  It is in your interest to have a lawyer represent you in arbitration, including in IDR related to the No Surprises Act.

Let Us Help You Today

A small business attorney can help you when the law requires arbitration and you need a lawyer to negotiate on your behalf.  Contact Tobin, O’Connor & Ewing for help.




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