Interview opportunity: New CMS guidance for arbitrators of out-of-network surprise billing payment disputes

For immediate release: Monday, March 20, 2023 

WASHINGTON — Legal attacks against the No Surprises Act have invalidated parts of the independent dispute resolution process in the law that prohibits balance billing for emergency care, air ambulance transportation and out-of-network care at in-network facilities. In response to a decision in one of those legal challenges, the Centers of Medicare and Medicaid Services (CMS) issued on Friday new guidance for arbitrators who settle payment disputes between out-of-network providers and health plans.

A federal district court opinion and order in February in Texas Medical Association, et al. v. United States Department of Health and Human Services et al., struck parts of the original rules issued by CMS, forcing CMS to issue the new guidance. The changes will likely have a substantial negative impact on the cost-saving goals of the law that went into effect on January 1, 2022. 

The No Surprises Act, which prevents about 1 million surprise medical bills every month, removes patients from payment disputes between health plans and providers. How those disputes are settled impacts what plans pay and could affect the price of patients’ premiums and co-insurance responsibility. 

The nuances of the independent dispute resolution system are difficult to explain to a layperson. Senior director of Health Care Campaigns for U.S. PIRG Education Fund Patricia Kelmar, J.D., who has been working with the Centers for Medicare and Medicaid Services to finalize some portions of the Act, is available to help translate the implications of the new guidance to your audience. She may be able to connect you with patients who have had bad experiences with surprise billing.

• If you have video needs, Patricia can do Zoom interviews either live or to tape.
• If you have audio needs, Patricia can speak either by Zoom or by phone, either live or to tape.
• If you have print needs, Patricia can speak either by Zoom or by phone.

Please contact Patricia at [email protected] or 609-651-7654. Or you can contact PIRG’s Director of Media Relations Mark Morgenstein at [email protected], 678-427-1671.

You can find out more about the No Surprises Act protections on the PIRG Education Fund website.