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Health Insurers, Providers Face All-or-Nothing Arbitration

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A team at Waller — a law firm in Nashville, Tennessee — has released a detailed analysis of how the new, federal No Surprises Act might really work, and where drafters have left large holes in need of regulatory spackling.

The new law was part of the Consolidated Appropriations Act, 2021.

(Related: House Surprise Billing Deal Gets Bipartisan Support in Senate)

One major part of the new law creates a framework for resolving billing disputes between out-of-network providers of emergency care and health plans, and between the plans and, what for patients are out-of-network providers working in in-network hospitals.

The law also will require plans to have up-to-date information about whether providers are in-network, and it will require providers to give patients estimates of what care will cost.

The authors of the new analysis note, for example, that providers that are clashing with health insurers will face a baseball-style, all-or-nothing form of arbitration: independent dispute resolution will have to approve one party’s proposal as is, without changing the proposal in an effort to “split the difference.”

The affected parties will need regulations to apply many of the new rules, and that Congress will probably have to write new legislation letter to fill legal gaps, the authors say.

The authors see treatment of out-of-network ambulances as especially concerning.

The new law should prevent air ambulance service surprise billing but says nothing about ground-based ambulance services, the authors say.

— Read ‘Surprise Medical Bill’ Witnesses Clash Over Binding Arbitrationon ThinkAdvisor.

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