What is the Qualified Payment Amount (QPA) and why is there so much controversy surrounding the interim rules announced by the departments with regard to its application in the Independent Dispute Resolution (IDR) process under the No Surprises … [Read more...] about Why so much controversy surrounding the No Surprises Act, Qualifying Payment Amount?
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Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
As previously indicated, several lawsuits have been filed challenging the rules under the No Surprises Act regarding the presumption for Independent Dispute Resolution (arbitration) that the Qualified Payment Amount (QPA), the median in-network … [Read more...] about Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
Concerns About the Federal No Surprises Act: Interim Final Rules According to an article published by KHN, the federal agencies responsible for issuing the regulations for the implementation of “the No Surprises Act” (NSA) have publicly … [Read more...] about Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
What’s So Great About Being An In-Network Provider Under the No Surprises Act
For years, insurance companies have operated networks of physicians and facilities which they pair with company benefit plans and their own insurance policies to facilitate “in-network” coverage for members. Physician networks are marketed by … [Read more...] about What’s So Great About Being An In-Network Provider Under the No Surprises Act
Breast Reconstruction and the Women’s Health and Cancer Rights Act (WHCRA)
The Women's Health and Cancer Rights Act (WHCRA), passed by Congress in 1998 and adopted as part of the Employee Retirement Income Security Act (ERISA), was enacted to protect women from abuses related to health plan coverage for a mastectomy and … [Read more...] about Breast Reconstruction and the Women’s Health and Cancer Rights Act (WHCRA)
Enforcement Provision of the No Surprises Act (NSA) Proposed Rule Issued
The Departments of Health & Human Services (HHS), Labor, and the Treasury together with the Office of Personnel Management (OPM) issued, on September 10, 2021, a second set of regulations under the No Surprises Act (NSA). The proposed rule … [Read more...] about Enforcement Provision of the No Surprises Act (NSA) Proposed Rule Issued
Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part IV: Know Who Is Paying Your Claim?
At face value, it seems logical that insurance companies are responsible for paying health benefit claims. But are they? Determining the entity responsible for paying claims requires an understanding of how health benefit plans are structured and … [Read more...] about Strategies and Solutions to Maximize Out-of-Network Reimbursements, Part IV: Know Who Is Paying Your Claim?
Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
The No Surprises Act (NSA) becomes effective on January 1, 2022 and will apply to virtually all commercial medical claims covered by ERISA, Non-ERISA, self-insured and fully insured plans for (1) emergency care performed by an out-of-network … [Read more...] about Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
No Surprises Act Regulations Part I Released
On July 1, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury issued part I of the regulations in connection with federal No Surprises Act that protects patients from surprise medical … [Read more...] about No Surprises Act Regulations Part I Released
Court Denies BCBSAL Motion to Dismiss Based on Anti-Assignment Clause in Medical Reimbursement Dispute Finding Derivative Standing Exists Under ERISA
Our client, an out-of-network orthopedics practice group, filed a lawsuit against Blue Cross Blue Shield of Alabama (BCBSAL) to dispute the medical reimbursement for a spinal surgery performed on July 12, 2016. The patient in the suit had coverage … [Read more...] about Court Denies BCBSAL Motion to Dismiss Based on Anti-Assignment Clause in Medical Reimbursement Dispute Finding Derivative Standing Exists Under ERISA
