News & Analysis as of

Physicians Out of Network Provider

Womble Bond Dickinson

California Supreme Court Expands Ability of Public Interest and Non-Profit Trade Groups to Sue for Alleged Unfair Business...

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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

Hendershot Cowart P.C.

Texas ER Physicians Sue Insurer for Underpayment – Thousands of Claims at Stake

Hendershot Cowart P.C. on

An appeal brought before the Texas Supreme Court could unleash a wave of legal action by out-of-network ER physicians pursuing insurers for underpayment of claims. Unlike in-network providers who negotiate reimbursement...more

Dentons

No Surprises Act: Frequently Asked Questions - Volume 2

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In 2020, Congress passed the No Surprises Act (NSA) in an attempt to protect patients from surprise billing. Some sections of the NSA became effective January 1, 2022, while other sections are on hold until regulations are...more

Maynard Nexsen

Good Faith Estimate Guidance for Physicians and Other Providers

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The No Surprises Act (the Act), enacted by Congress on December 27, 2020, as part of the Consolidated Appropriations Act of 2021, includes important new protections for self-pay patients that recently became effective on...more

Health Care Compliance Association (HCCA)

[Webinar] Out-of-Network and Balance Billing Restrictions - November 3rd, 12:00 pm - 1:30 pm CDT

Learning Objectives: - Obtain a high-level overview of the federal No Surprises Act - Identify state laws regarding balance billing and how they interact with the new federal law - Explain the effects on communication...more

Rivkin Radler LLP

[Webinar] Lunch-and-Learn Series: Recent Developments in Telehealth: For the Pandemic and Beyond - November 18th, 12:00 pm - 1:00...

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Please join us as Rivkin Radler Partner Eric D. Fader provides an overview of changes in the provision of telehealth services and federal and state regulation of them, since the beginning of the COVID-19 pandemic. New rules...more

Manatt, Phelps & Phillips, LLP

[Webinar] Accessing Out-of-Network Cancer Care: Policy Challenges & Solutions - September 2nd, 2:00 pm - 3:00 pm ET

In a New Webinar, Manatt and the Leukemia & Lymphoma Society Share the Obstacles Cancer Patients Face to Receiving Proper Treatment—and the Policies States and Plans Can Implement to Improve Network Adequacy and Access. ...more

Manatt, Phelps & Phillips, LLP

[Webinar] Navigating the No Surprises Act: Your Guide to Requirements, Challenges & Compliance - August 2nd, 1:00 pm - 2:00 pm ET

What New Obligations Does the No Surprises Act Impose on Health Systems and Health Plans—and How Can You Prepare for the Impact? Learn the Answer at a New Manatt Webinar. The No Surprises Act (NSA)—set to take effect...more

Bradley Arant Boult Cummings LLP

No More Surprises? New Rule on Surprise Medical Bills

The U.S. Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management have issued "Requirements Related to Surprise Billing; Part I," an interim final rule to implement the No...more

Manatt, Phelps & Phillips, LLP

Accessing Out-of-Network Subspecialty Cancer Care in Marketplace Plans - Key Findings From a Scan of Four States

Blood cancer takes a demanding physical, mental and emotional toll on the 1.3 million patients living with this disease in the U.S. Many blood cancer patients also face the daunting task of managing their own care—obtaining...more

Groom Law Group, Chartered

[Webinar] Surprise Billing Law Imposes New Requirements for Plans and Issuers - January 13th, 2:00 pm - 3:30 pm ET

This webinar will include a discussion on the various provisions of the new surprise billing law, how it interacts with current law, expected guidance from the Biden Administration, and implications for health insurance...more

Sheppard Mullin Richter & Hampton LLP

No Surprises Act Comes as a Surprise – Consolidated Appropriations Act Includes New Restrictions on Surprise Bills

On December 28, 2020, the Consolidated Appropriations Act, 2021 (“Appropriations Act”) was passed into law. The Appropriations Act included the No Surprises Act (“Act”), which seeks to protect patients from surprise medical...more

White and Williams LLP

Congress Bans Surprise Medical Bills

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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

Troutman Pepper

Surprise Medical Bill Legislation: The Devil Is in the Details

Troutman Pepper on

Congress has been working for months to pass legislation protecting patients from surprise medical bills that arise when insured patients unknowingly receive out-of-network (OON) care, usually when receiving emergency medical...more

King & Spalding

House Committees Release Competing Surprise Medical Billing Legislative Proposals

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On February 7, 2020, two House committees released competing proposed bills designed to shield patients from “surprise” medical bills. These bills, like others that were proposed last year, would protect patients from...more

Sheppard Mullin Richter & Hampton LLP

Surprise Billing Initiatives Face Not-So-Surprising Resistance

“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

Burr & Forman

Protecting Patients from “Surprise” Medical Bills

Burr & Forman on

Lawmakers in both the United States House and Senate are considering two proposals to address unexpected, patient medical bills from out-of-network providers. Often referred to as “surprise medical bills” or “balance...more

Baker Donelson

Surprise Medical Billing Gains Momentum in Washington

Baker Donelson on

Over the last few weeks, President Trump and lawmakers in both the House and Senate have taken several steps to protect patients from surprise medical bills, the latest signs of bipartisan momentum to address the issue this...more

Holland & Knight LLP

Hospitals, Doctors (and Others) Beware: DOJ May Apply Travel Act to Healthcare Prosecutions - Arrangements Viewed Under the...

Holland & Knight LLP on

• A recent federal jury verdict in Dallas affirms the U.S. Department of Justice's determination to extend federal prosecutions to healthcare arrangements involving commercial payers by utilizing the federal Travel Act, which...more

Fox Rothschild LLP

NJ Medical Practices Must Update Patient Disclosures To Comply With Out-Of-Network Billing Law

Fox Rothschild LLP on

The New Jersey Department of Banking and Insurance (DOBI) has issued an 18-page Bulletin on implementation of the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act by health care...more

Saul Ewing LLP

New Jersey Enacts Out-of-Network Statute Affecting Hospitals, Surgery Centers, Physicians and Insurers

Saul Ewing LLP on

On June 1, 2018, New Jersey Governor Phil Murphy signed into law the “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” (the “Act”). In the preamble to the Act, the New Jersey...more

Sheppard Mullin Richter & Hampton LLP

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

Foley & Lardner LLP

Will the Massachusetts Proposed Legislation on Hospital Outpatient Facility Fees Have a Nationwide Impact?

Foley & Lardner LLP on

In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more

Buchalter

Are You Ready for AB 72?

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To protect patients from receiving an unexpected surprise bill when they seek care at in-network facilities from out-of-network providers, Governor Brown signed AB 72: California’s surprise out-of-network law. The new law...more

Sheppard Mullin Richter & Hampton LLP

When your Hospital-of-Choice is In-Network but, SURPRISE, your Anesthesiologist is Not: California’s AB-72 and Other State...

Regardless of a patient’s diligence in selecting an in-network hospital, ambulatory surgery center, or other health facility for treatment, patients are still being saddled with surprisingly high medical bills that include...more

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