The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors
Video: Getting Ready for the No Surprises Act - Thought Leaders in Health Law
In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more
The U.S. Court of Appeals for the Ninth Circuit recently issued an opinion with critical implications for the healthcare industry. This court decision clarifies the expansive reach of the Employee Retirement Income Security...more
Can an organization sue you simply because it chose to divert resources to respond to your allegedly unfair business practices by claiming your practices are a perceived threat to its mission? The California Supreme Court...more
In light of the increasing demand for mental health treatment and simultaneous provider shortages, the private insurance industry is rolling out targeted initiatives to increase mental health support for members by mitigating...more
On November 29, 2021, a jury in Nevada found United Healthcare liable for underpaying TeamHealth, a nationwide provider of emergency medical services, by millions of dollars. The case, Fremont Emergency Services vs....more
Over the last several years, both the federal government and a number of state legislatures have sought to find a solution to the billing by out-of-network providers, referred to as “Out of Network Billing” (OON Billing) and...more
Today, the Departments of Health and Human Services (HHS), Labor, and Treasury (the Departments) published an interim final rule (the Interim Final Rule) implementing certain provisions of the No Surprises Act,[1] which aims...more
In the closing days of 2020, Congress passed federal legislation aimed at protecting patients against surprise medical bills and facilitating payment dispute resolutions among providers and insurers. Slated to take effect on...more
On December 21, 2020, as part of the nearly 5,600-page coronavirus economic relief package, a measure entitled the “No Surprises Act” was included to ban surprise medical bills. Once the “No Surprises Act” goes into effect...more
“Surprise billing,” also known as “balance billing,” is one of few areas that garners bipartisan support. Surprise billing occurs when a patient inadvertently goes out of his or her insurer’s network, resulting in a “surprise...more
Balanced billing or “surprise billing” has been getting increased attention at both the federal and state level. Balance bills arise when a payor covers out-of-network care, but the provider bills the patient for amounts...more
Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more
On April 13, 2016, a jury in Santa Clara, California awarded Aetna, Inc. $37.4 million from Bay Area Surgical Management, LLC (“BASM”), six of its affiliated surgery centers and its three principals. Aetna had accused the...more
In the past five years or so an increasing number of health insurers have been using “narrow networks” of providers in an attempt to hold down medical costs and insurance premium rates. A key part of the narrow network...more
On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more
New York State has adopted legislation to address consumer complaints related to health insurance coverage and "surprise bills" for health care services performed by out-of-network physicians and providers....more