News & Analysis as of

Surprise Medical Bills Out of Network Provider

Ballard Spahr LLP

Fifth Circuit Affirms Invalidity of No Surprises Regulations

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The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules....more

Harris Beach PLLC

Court Rejects IDR Rules in No Surprises Act Case

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Out-of-network health providers recently won a huge legal victory when the Fifth Circuit Court ruled that federal guidelines regarding Independent Dispute Resolution (“IDR”) proceedings were unlawfully slanted in favor of...more

Troutman Pepper

Fifth Circuit Affirms Vacatur of Insurer-Friendly "No Surprises Act" Regulations

Troutman Pepper on

In a win for health care providers, on August 2, the Fifth Circuit Court of Appeals affirmed a Texas federal judge’s grant of summary judgment in favor of the Texas Medical Association and LifeNet, an air ambulance company,...more

Hall Benefits Law

The No Surprises Act: A Cost Saving Opportunity for Employer Plan Sponsors

Hall Benefits Law on

Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more

Manatt, Phelps & Phillips, LLP

[Webinar] Strengthening the NSA’s Independent Dispute Resolution Process: Stakeholder Perspectives - January 18th, 1:00 pm - 2:00...

The No Surprises Act (NSA), enacted in 2020, protects patients from surprise medical bills for emergency services and, in certain circumstances, when treated by out-of-network providers in an in-network facility. Since the...more

Tucker Arensberg, P.C.

Biden Administration to Appeal Surprise Billing Defeat

Tucker Arensberg, P.C. on

As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations.  Thereafter, CMS halted the arbitration process for resolving disputes regarding...more

Ballard Spahr LLP

No Surprises, But Much Uncertainty: The Status of CAA Billing Rules

Ballard Spahr LLP on

Summary - The rules in the Consolidated Appropriations Act that aim to eliminate much of the surprise from billings by out-of-network providers in particular situations are the subject of continued controversy....more

Snell & Wilmer

2023 End-of-Year Plan Sponsor “To Do” Lists (Part 1) Health and Welfare

Snell & Wilmer on

We are pleased to present our annual End of Year Plan Sponsor “To Do” Lists. This year, we present our “To Do” Lists in four separate Employee Benefits Updates. This Part 1 covers year-end health and welfare plan issues....more

Foley & Lardner LLP

The No Surprises Act: The Departments Proposed Another Increase to IDR Fee, Will it Stick?

Foley & Lardner LLP on

On September 26, 2023, the Departments of Health & Human Services (HHS), Labor, and the Treasury (collectively, the Departments) jointly proposed rules (September Rule) updating the administrative fee and Certified...more

Akerman LLP - Health Law Rx

THE NO SURPRISES ACT: Hoping for an End to the Surprises

By looking at the events that have transpired since the Consolidated Appropriations Act, 2021, which includes the No Surprises Act (the Act), was signed into law, it is clear that the Departments of Health and Human Services,...more

Cornerstone Research

5 Questions with Erin Trish: Surprise Billing in Healthcare

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5 Questions is a periodic feature produced by Cornerstone Research, which asks our professionals, senior advisors, or affiliated experts to answer five questions. We interview Professor Erin Trish, of the Schaeffer Center...more

Bass, Berry & Sims PLC

Court Strikes Down Federal Surprise Billing QPA Calculation Rules, Continuing Pause on Arbitrations

Bass, Berry & Sims PLC on

On August 24, the U.S. District Court for the Eastern District of Texas once again struck down parts of the regulations governing the arbitration process created by the No Surprises Act (NSA) to settle payment disputes...more

Sheppard Mullin Richter & Hampton LLP

Another No Surprises Act Update: Texas Court Vacates Rules and Guidance Related to the “Qualified Payment Amount”

On August 24, 2023, the United States District Court for the Eastern District of Texas again largely ruled in favor of the Texas Medical Association and other plaintiffs (including air ambulance providers) and vacated certain...more

Kramer Levin Naftalis & Frankel LLP

Ghostbusters: In a New Win for Providers, No Surprises Act Rules Struck for Allowing Ghost Rates

Last week, the federal government met its fourth loss in a challenge brought by health care and air ambulance providers against No Surprises Act (NSA) regulations. We wrote about the previous victories by out-of-network...more

Epstein Becker & Green

Texas Federal Court Issues Fourth Ruling Invalidating Parts of the Administration’s No Surprises Act Regulations

Epstein Becker & Green on

On August 24, 2023, the U.S. District Court for the Eastern District of Texas issued an opinion and order in Texas Medical Association, et al. v. United States Department of Health and Human Services(“HHS”)(“TMA III”). TMA...more

Akerman LLP - Health Law Rx

Surprise… No Surprises Act Arbitration Is Too Expensive

Providers finally obtained court ordered relief to the $350 administrative fee each party was required to pay as part of the Federal Independent Dispute Resolution (IDR) Process under the No Surprises Act. Until the...more

Epstein Becker & Green

Independent Dispute Resolution Process Halted Following the Government’s Third Major No Surprises Act-Related Loss in Federal...

Epstein Becker & Green on

On August 3, 2023, the U.S. Department of Health & Human Services (“HHS”), the Department of Labor, and the Department of Treasury (collectively, the “Departments”) temporarily suspended the federal Independent Dispute...more

Sheppard Mullin Richter & Hampton LLP

No Surprises Act Update: Federal IDR Temporarily Suspended After Court Vacates Increased Administrative Fees and Rule for Batching...

On August 3, 2023, the United States District Court for the Eastern District of Texas once again ruled in favor of the Texas Medical Association[1] and vacated portions of the guidance related to (i) the administrative fee...more

Tucker Arensberg, P.C.

CMS Halts “No Surprises Act” Arbitration

Tucker Arensberg, P.C. on

CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows...more

Kramer Levin Naftalis & Frankel LLP

No Surprises Here: Providers Score Third Victory in No Surprises Act Litigation, Other Challenges to the NSA Continue

Congress enacted the No Surprises Act (NSA) in 2020 to reduce surprise medical bills and to provide a simple and fast procedure for out-of-network health care providers to obtain payment from insurers. The U.S. Department of...more

McDermott Will & Emery

Agencies Issue FAQs on Surprise Billing and Cost-Sharing Rules Coordination

McDermott Will & Emery on

A recent article by the Kaiser Family Foundation (KFF) and National Public Radio (NPR) raised the prospect that patients may still see surprise medical bills despite the enactment of the No Surprises Act (NSA)....more

King & Spalding

First Annual Report on the No Surprises Act’s Impact on the Health Care Market is Released

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On July 6, 2023, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released the first of five required annual reports on the impact of the No Surprises Act (NSA) on health care markets (the Report)....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

No Surprises Act Guidance on Out-of-Pocket Maximums and Facility Fees

Employers have some new clarity on the No Surprises Act rules on out-of-network providers and charges under new guidance from the U.S. Department of Labor, U.S. Department of the Treasury, and the U.S. Department of Health...more

Maynard Nexsen

CMS Publishes New No Surprises Act “Consumer-Friendly” Resources Webpage

Maynard Nexsen on

Providers should be aware consumers now have access to CMS resources that help them understand their rights under the No Surprises Act (NSA). In general, the NSA protects healthcare consumers from receiving surprise medical...more

Kramer Levin Naftalis & Frankel LLP

DFS Issues Guidance on Surprise Billing Disputes

Accident and health (A&H) insurers and health maintenance organizations (HMOs) doing business in New York should consider new guidance from the New York Department of Financial Services on the independent dispute resolution...more

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