Nathan Martinez Discusses the Government’s Attempt to Address Out of Network Healthcare Billing

In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays.  With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer. During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com