aequum CEO Christine Cooper and ERISA attorney Jack Towarnicky joined Jim Farley on The J.P. Farley Show to examine how self-funded employers should approach No Surprises Act (NSA) payment disputes and arbitration awards.
aequum helps plans address these challenges through technology-supported medical bill defense and participant advocacy, protecting plan assets while supporting the people covered by the plan. The episode brought together Christine’s experience with reimbursement disputes and Jack’s perspective on employer fiduciary responsibilities.
Patient Protection Leaves Financial Questions for Employers
The NSA protects patients from certain out-of-network balance bills. When providers and plans cannot agree on payment for eligible claims through open negotiation, the federal Independent Dispute Resolution (IDR) process provides a way to determine reimbursement. Resolving those disagreements can involve arbitration fees and administrative expenses alongside the payment itself.
Jack explained why these costs matter beyond the individual claim. Additional healthcare spending can affect employee contributions, benefit design and the resources employers have available for compensation. Moving a billing dispute away from the patient does not eliminate its economic consequences.
Payment Obligations and Enforcement Are Different Issues
Christine described an enforcement gap in the IDR process. Although the statute requires payment within 30 calendar days, she questioned the practical mechanisms for compelling that payment.
CMS describes federal IDR determinations as binding. Whether a particular award can be challenged, and what a plan may do while that question is examined, requires qualified counsel’s review of the facts and applicable law.
Fiduciary Oversight Starts Before an Award
“Plan sponsors are not potted plants,” Jack said, emphasizing the need for employers to scrutinize disputed payments.
That oversight begins with reviewing whether a claim belongs in federal IDR, monitoring procedural deadlines and retaining evidence supporting the plan’s position. Raising eligibility concerns during the process gives the plan an opportunity to address them before a payment determination.
For ERISA fiduciaries, documenting the basis for decisions also supports their responsibility to act prudently in participants’ interests.
How aequum Helps Plans Respond
aequum gives employers and TPAs a specialized resource when medical billing disputes extend beyond routine claims administration. aequum’s knowledge of NSA procedures helps partners evaluate referred matters within the applicable framework, while its advocates coordinate communication with providers, payers and collection agencies.
When a dispute requires legal representation, Koehler Fitzgerald LLC provides attorneys who can assist with negotiation, litigation and appeals. aequum’s proprietary relational database supports customizable reporting on claim status, disputed amounts, settlements and financial outcomes, giving employers visibility into the handling of each referred matter.
Watch Christine and Jack’s full conversation on The J.P. Farley Show. Contact aequum to discuss support for your plan’s NSA reimbursement disputes and participant billing concerns.