Providers Win Lawsuit Over No Surprises Act’s Independent Dispute Resolution Rule
Healthcare providers recently secured a significant legal victory regarding the No Surprises Act (NSA) and its independent dispute resolution (IDR) process. While the NSA was designed to protect patients from surprise medical bills, disputes between providers and insurers have persisted, particularly when it comes to the IDR process used to settle payment disagreements. A recent court ruling struck down parts of the IDR rule, handing a win to providers.
The NSA, which took effect in January 2022, was created to protect patients from unexpected medical bills when they receive care from out-of-network providers, especially in emergencies. These surprise bills usually happen when patients unknowingly receive care from out-of-network providers at in-network hospitals or when they don’t have control over which provider they see, typically during an emergency. In general, the NSA stops group health plans and health insurers from billing patients more than their in-network cost-sharing amount for certain out-of-network services, including:
- Emergency services,