Surprise Billing

About Surprise Billing

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. While California hospitals are already leaders in ensuring patients understand their out-of-pocket costs and offering clear, written discount and charity care policies to help certain patients, new AHA guidelines are a way for hospitals to reinforce their commitment.

Independent Dispute Resolution Portal Reopening for Certain Disputes

What’s happening: The departments of Health and Human Services, Labor, and Treasury are reopening the independent dispute resolution (IDR) portal for all batched disputes and single air ambulance disputes.  

What else to know: The portal has been closed since federal agencies suspended all IDR process operations in August to align with the district court’s opinions and orders in TMA III and TMA IV.  

Changes Proposed for Independent Dispute Resolution Process

What’s happening: A proposed rule from the departments of Health and Human Services, Labor, and Treasury aims to improve the No Surprises Act (NSA) independent dispute resolution (IDR) process.  

What else to know: Comments on the proposal, which is in response to court rulings that held key provisions of the interim final rules establishing the IDR process impermissible under the NSA, are due Jan. 2.  

Independent Dispute Resolution Process Updated

The departments of Health and Human Services, Labor, and the Treasury (the departments) have updated guidance regarding the No Surprises Act independent dispute resolution (IDR) process. The departments have directed certified IDR entities to resume processing all single and bundled disputes submitted on or before Aug. 3, 2023. 

District Court Disallows Certain Provisions Related to No Surprises Act

For the third time, the U.S. District Court for the Eastern District of Texas ruled to set aside certain regulations implementing the No Surprises Act. The Texas Medical Association, joined by several air ambulance providers and supported by an amicus brief filed by the American Hospital Association, successfully argued that the methodology used to calculate the qualifying payment amount (QPA) favors insurers during the arbitration process.  

FAQs Issued on No Surprises Act Price Transparency Requirements

On July 7, the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight issued the new No Surprises Act (NSA) frequently asked questions (FAQs). While the FAQs cover several topics, most importantly, they clarify that “facility fees” are included in the definition of “items and services” for purposes of the machine-readable file that health plans are required to post under the NSA’s Transparency in Coverage provisions and the provider uninsured good faith estimate requirements.