No Surprises Act Arbitration Update

The No Surprises Act IDR process has had many starts and stops this year, creating even a greater backlog of cases. Needless to say, it has not been a smooth roll out. During the period between April 15, 2022 and June 30, 2023, 490,000 disputes were initiated — more than 22 times the amount of … Continued

Total Health Benefit Costs Projected to Rise In 2024, According To Mercer National Survey

With annual open enrollment approaching, employers and employees alike are at heightened levels of stress over the potential for significant increases in benefit costs. End-of-year health plan renewals may see significant increases in the cost of coverage, potentially resulting in higher employer and employee contributions and/or higher point of purchase cost sharing (deductibles, copayments, etc.). … Continued

Federal Court Rules Against Association of Air Medical Services: A Win for Patients and Payers and a Huge Loss for Air Ambulance Companies

The federal government prevailed at summary judgment in a case brought by the Association of Air Medical Services (the “Association”) against the U.S. Department of Health and Human Services et al. (“HHS”), marking it the government’s first major victory in the string of court challenges to the No Surprises Act (the “NSA”). No Surprises Act … Continued

Survey Reveals Provider Frustrations Over No Surprises Act, Alleges Payers Ignore Independent Dispute Resolution Rulings

While the No Surprises Act (NSA) intends to end surprise medical billing, also known as balance billing, and protect patients from receiving high out-of-network charges in certain situations, there remain challenges with enforcement over rulings made through the Independent Dispute Resolution (IDR) process. A new survey conducted by the Americans for Fair Health Care (AFHC) … Continued

Texas Medical Association Case Rulings: One Prompted HHS to Reduce Fees for Independent Dispute Resolution, A Second Rejects Regulations That Defined the Qualified Payment Amount

Compliance with the No Surprises Act (NSA) remains a priority for employer-sponsored health plans The NSA ends surprise medical billing, also known as balance billing, in certain situations – such as emergency care or services from out-of-network providers at in-network facilities. Physicians and other payers continue to challenge agency regulations implementing NSA, specifically provisions that … Continued

Price Transparency Has Limited Value if Not “Done Right”

Advance Transparency in Coverage (TiC) rules require employers to provide employees with easy access to an online shopping tool featuring 500 shoppable services and highlighting personalized out-of-pocket cost information for covered healthcare items and services. These pivotal transparency mandates are intended to spearhead a massive shift in the role of the patient as a healthcare … Continued

HHS’s First Annual Report Evaluating the Impact of the No Surprises Act

The Departments of Health and Human Services (HHS) issued the first annual report on the impact of the No Surprises Act (NSA). The report “focuses largely on establishing a baseline and a framework for further evaluation” and “details key trends in factors that will be important to evaluate NSA effects including: the implementation and impacts … Continued