Medical Billing Disputes Create Noise. We Handle It So You and Your People Don't Have To.
When a provider challenges a self-funded health plan's payment, or a plan participant receives a balance bill they don't know how to handle, most employers have nowhere to turn. aequum provides medical billing advocacy and legal defense for self-funded health plans and their plan participants, managing out-of-network billing disputes, defending against balance billing, and handling No Surprises Act IDR cases so the noise stops and the plan stays protected.Legal Strategies for Healthcare Cost Containment
Healthcare costs can be influenced by many factors, including provider pricing, billing complexity, and administrative challenges. aequum helps self-funded health plans identify opportunities to reduce unnecessary costs, support plan participants through billing-related issues, and facilitate resolution of payment disputes before they become larger challenges. The solutions below highlight two of the primary ways we help plans manage costs and improve member experience.
Medical Billing Defense
We defend plans and members against inflated out-of-network bills, collections pressure, balance billing, and the noise that follows when disputes go unmanaged. When a provider issues an inflated out-of-network bill or attempts to balance bill a member, most self-funded employers don't have the internal resources to respond effectively. aequum reviews the bill, contacts the provider, challenges improper charges, and manages the dispute end to end. The plan is defended. The member isn't left alone.No Surprises Act Defense
We manage the NSA IDR process for payers so you don't have to bear the administrative burden and defend against unfair or improper awards. The No Surprises Act protects patients from surprise bills. For health plans, it also created the Independent Dispute Resolution (IDR) process, a federal arbitration system that providers are using aggressively to demand payments well above what the plan originally paid. Without active defense, self-funded plans routinely overpay. aequum reviews whether disputes even qualify, manages open negotiations, and defends IDR cases with a consistent legal strategy.Why aequum Is Different
Self-funded health plans face a complex healthcare ecosystem with multiple stakeholders, evolving regulations, and rising costs. Successfully managing plan spend requires more than simply processing claims. It requires visibility, advocacy, and proactive cost-containment strategies. aequum works alongside employers, brokers, administrators, and other partners to help plans identify unnecessary costs, support plan participants through billing challenges, and provide documentation that supports fiduciary oversight and informed decision-making. Our collaborative approach helps plans control costs while improving the member experience.Attorney-Backed Advocacy
aequum's work is grounded in legal practice. Through its partnership with a national law firm, every dispute is handled with attorney-level precision, not just administrative follow-up.
We Step In Early
Disputes can take many forms, from out-of-network billing challenges to collection notices and member concerns. aequum helps self-funded health plans and plan participants navigate these issues strategically, providing legal advocacy and billing support at every stage of the process.
Audit-Ready Reporting
Every dispute is tracked and documented. Plan sponsors get full visibility into how disputes are being handled, which is the paper trail ERISA fiduciary responsibility requires.
Trusted Across the Self-Funded Market.
Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.
We've been working with aequum for over 3 years and couldn't be happier. Their knowledge and advice has been invaluable to us as a Third Party Administrator.
Aequum's expertise in balance billing disputes and IDR proceedings strengthens the foundation of the pricing solutions we deliver at ClaimsBridge. Their ability to navigate complex regulatory frameworks while driving practical outcomes makes them a trusted and highly valued partner in the self-insured market.
Who We Work With
aequum works with self-funded employers, third-party administrators (TPAs), brokers, stop-loss carriers, reference-based pricing plans, and cost-containment partners across the United States. If your plan is dealing with out-of-network billing disputes, No Surprises Act IDR exposure, or health plan compliance questions, we're built for that.
"We keep getting hit with out-of-network bills our plan didn't expect to pay."
Mid-sized to larger employers running a self-funded health plan who need active out-of-network billing defense and want to stop overpaying on disputed claims.
"Our clients are getting NSA IDR filings and we don't have a legal defense in place."
Third-party administrators managing self-funded plans who need support with balance billing disputes, NSA compliance and IDR matters, particularly those with reference-based pricing (RBP) arrangements or high out-of-network claim volume.
"Providers keep balance billing our members and we're spending too much time managing it."
Reference-based pricing plans pay claims based on a reference price, typically a percentage above the Medicare rate, which saves money but regularly triggers provider balance billing attempts. We defend RBP payment determinations and manage those disputes so the plan operates without constant friction.
"My clients need more than I can offer when billing disputes turn into collections pressure."
Brokers looking to deliver additional value to self-funded clients through healthcare cost-containment solutions, participant advocacy services, and support for complex billing and payment challenges. aequum helps brokers strengthen client relationships while addressing issues that can significantly impact plan costs and member satisfaction.
"We can reprice the claim. But when a provider pushes back legally, we need backup."
Cost-containment organizations that provide innovative health plan solutions including repricing, care navigation, payment integrity, and other cost-management services often benefit from additional support when complex billing disputes arise. aequum complements these offerings with specialized advocacy services and access to legal resources through its law firm partnership.