"The No Surprises Act protects patients from unexpected bills and removes them from insurer-provider payment friction. The act requires insurers and providers to enter into 30 days of open negotiation to determine how much providers are paid. If they can't come to an agreement, either side can use the Independent Dispute Resolution (IDR) process, in which a provider submits a payment offer and an insurer submits a payment offer and then a neutral arbitrator picks one."
"But some in the industry now argue that the IDR process is being misused by providers leading to an explosion of cases using this mechanism. Anthem Blue Cross Life and Health Insurance Company, an Elevance affiliate,filed a lawsuit earlier in January against 11 Prime Healthcare facilities in California. Anthem is accusing these facilities of "knowingly flooding" the IDR process with more than 6,000 ineligible disputes and "extracting millions of dollars in wrongfully obtained awards.""
Before the No Surprises Act, patients often received unexpected bills when treated by out-of-network providers at in-network hospitals or in emergencies. The No Surprises Act (2022) shields patients from surprise bills and requires insurers and providers to negotiate for 30 days before using Independent Dispute Resolution (IDR). In IDR each side submits an offer and a neutral arbitrator chooses one. IDR was intended as a last resort, but filings have surged amid allegations of misuse. Anthem sued 11 Prime Healthcare facilities, alleging over 6,000 ineligible IDR disputes and millions in wrongful awards; Elevance has cases in Georgia and Ohio.
Read at MedCity News
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