Provider-friendly Surprise Bill Proposal

The deep divide between insurers and providers over the best approach to end the practice of surprise billing patients appears to be narrowing, according to coverage by Politico published on Friday as new legislation is expected to be part of the year-end funding package. The latest proposal, ‘calls for parties to negotiate an agreed-upon rate or bring their dispute to a mediator’ for resolution, a practice that has successfully been employed at the state level. This legislation would apply to self-funded plans that are not currently regulated by State laws on this issue.

It is reported, mediators will be able to rule on billing disputes that are ‘batched’ together. Cohen Howard, considers this to be an advantage for providers and our clients, in particular, as we have constructed a comprehensive data base of thousands of out-of-network payments made by insurance companies across the country with the capability of identifying patterns and practices including but not limited to geographical and CPT code level data sets.

The Senate extended the funding bill to later this week. We will update this information as warranted.

https://www.politico.com/news/2020/12/11/congress-surprise-medical-bill-444593

#medicalbilling #surprisebilling #claimsreimbursements #outofnetwork

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Notable Cases

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Corporation et al, Case No. 3:22-cv-00769-OAW, District of Connecticut (New Haven). Date Filed: 06/10/2022.

Lawsuit v. Multiplan, Inc.

et al, Case No. 1:21-cv-02421-LLS, Southern District of New York (Foley Square). Date filed: 03/19/2021.

Class Action v. UnitedHealth Group Incorporated

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Lawsuit v. Multiplan, Inc.

Inc. et al, Case No. 1:20-cv-10685-LLS, Southern District of New York (Foley Square). Date filed: 12/18/2020.

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