Here’s a quick rundown of what’s new on the No Surprises Act front this month.
First, a corporate medicine story out of Oregon. A group of independent ER doctors was about to be replaced by a national staffing company. They fought back under Oregon’s new law banning corporate control of medical practices, and the hospital backed down before the judge even ruled. California and Vermont have similar laws now, so expect more of these fights.
Second, a heads up on an Aetna EOB code some of you may start seeing. It claims that once a patient is notified of network status at precertification, surprise billing protections no longer apply and the claim isn’t eligible for IDR. That’s not how NSA waiver works. If you see this code, don’t take it at face value. Send it to us.
Third, several court wins worth knowing about. Courts in Arizona, Maryland, New York, and here in New Jersey keep confirming that unpaid IDR awards are enforceable. We also picked up two rulings sending cases back to state court, which keeps state law claims alive even where federal courts have found no right to sue under the NSA directly. And one of our own New Jersey cases stays on the faster litigation track, over the carrier’s objection.
All the details, including the actual court orders and quotes, are in the full update sent to our email list.
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And if you have questions about how any of this affects your practice, reach out anytime.
