Latest news with #NoSurprisesAct
Miami Herald
14-07-2025
- Health
- Miami Herald
Insurers fight state laws restricting surprise ambulance bills
Nicole Silva's 4-year-old daughter was headed to a relative's house near the southern Colorado town of La Jara when a vehicle T-boned the car she was riding in. A cascade of ambulance rides ensued - a ground ambulance to a local hospital, an air ambulance to Denver, and another ground ambulance to Children's Hospital Colorado. Silva's daughter was on Medicaid, which was supposed to cover the cost of the ambulances. But one of the three ambulance companies, Northglenn Ambulance, a public company since acquired by a private one, sent Silva's bill to a debt collector. It was for $2,181.60, which grew to more than $3,000 with court fees and interest, court records show. The preschool teacher couldn't pay, and the collector garnished Silva's wages. "It put us so behind on bills - our house payment, electric, phone bills, food for the kids," said Silva, whose daughter recovered fully from the 2015 crash. "It took away from everything." Some state legislators are looking to curb bills like the one she received - surprise bills for ground ambulance rides. When an ambulance company charges more than an insurer is willing to pay, patients can be left with a big bill they probably had no choice in. States are trying to fill a gap left by the federal No Surprises Act, which covers air ambulances but not ground services, including ambulances that travel by road and water. This year, Utah and North Dakota joined 18 other states that have passed protections against surprise billing for such rides. Those protections often include setting a minimum for insurers to pay out if someone they cover needs a ride. But the sticking point is where to set that bar. Legislation in Colorado and Montana stalled this year because policymakers worried that forcing insurers to pay more would lead to higher health coverage costs for everyone. Surprise ambulance bills are one piece of a health care system that systematically saddles Americans with medical debt, straining their finances, preventing them from accessing care, and increasing racial disparities, as KFF Health News has reported. "If people are hesitating to call the ambulance because they're worried about putting a huge financial burden on their family, it means we're going to get stroke victims who don't get to the hospital on time," said Patricia Kelmar, who directs health care campaigns at PIRG, a national consumer advocacy group. "It means that person who's worried it might be a heart attack won't call." The No Surprises Act, signed into law by President Donald Trump in 2020, says that for most emergency services, patients can be billed for out-of-network care only for the same amount they would have been billed if it were in-network. Like doctors or hospitals, ambulance companies can contract with insurers, making them in-network. Those that don't remain out-of-network. But unlike when making an appointment with a doctor or planning a surgery, a patient generally can't choose the ambulance company that will respond to their 911 call. This means they can get hit with large out-of-network bills. Federal lawmakers punted on including ground ambulances, in part because of the variety of business models - from private companies to volunteer fire departments - and a lack of data on how much rides cost. Instead, Congress created an advisory committee that issued recommendations last year. Its overarching conclusion - that patients shouldn't be stuck in the crossfire between providers and payers - was not controversial or partisan. In Colorado, a measure aimed at expanding protections from surprise ambulance bills got a unanimous thumbs-up in both legislative chambers. Colorado had previously passed a law protecting people from surprise bills from private ambulance companies. This new measure was aimed at providing similar protections against bills from public ambulance services and for transfers between hospitals. "We knew it had bipartisan support, but there are some people that vote no on everything," said a pleasantly surprised Karen McCormick, a Democratic state representative. A less pleasant surprise came later, when Gov. Jared Polis, who is also a Democrat, vetoed it, citing the fear of rising premiums. States can do only so much on this issue, because state laws apply only to state-regulated health plans. That leaves out a lot of workers. According to a 2024 national survey by KFF, a health information nonprofit that includes KFF Health News, 63% of people who work for private employers and get health insurance through their jobs have self-funded plans, which aren't state-regulated. "It's why we need a federal ambulance protection law, even if we passed 50 state laws," Kelmar said. According to data from the Colorado secretary of state's office, the only lobbying groups registered as "opposing" the bill were Anthem and UnitedHealth Group, plus UnitedHealth subsidiaries Optum and UnitedHealthcare. As soon as the legislative session ended in May, Kevin McFatridge, executive director of the Colorado Association of Health Plans, a trade group representing health insurance companies in the state, sent a letter to the governor requesting a veto, with an estimate that the legislation would result in premiums rising 0.4%. The Colorado bill said local governments - such as cities, counties, or special districts - would set rates. "We are in a much better place by not having local entities set their own rates," McFatridge told KFF Health News. "That's almost like the fox managing the henhouse." Jack Hoadley, an emeritus research professor with Georgetown University's McCourt School of Public Policy, said it isn't clear whether state laws approved elsewhere are raising premiums, or if so by how much. Hoadley said Washington state is expected to come out with an impact analysis of its law in a couple of years. The national trade association for insurance companies declined to provide a comment for this article. Instead, AHIP forwarded letters that its leaders submitted to lawmakers in Ohio, West Virginia, and North Dakota this year opposing measures in each state to set base ambulance rates. AHIP leadership described the proposals as inflated, government-mandated pricing that would reduce insurers' chance to negotiate fair prices. Ultimately, the association warned, the proposed minimums would increase health care costs. In Montana, legislators were considering a minimum reimbursement for ground ambulances of 400% of what Medicare pays, or at a set local rate if one exists. The proposal was sponsored by two Republicans and backed by ambulance companies. Health insurers successfully lobbied against it, arguing that the price was too steep. Sarah Clerget, a lobbyist representing AHIP, told Montana lawmakers in a legislative hearing that it's already hard to get ambulance companies to go in-network with insurers, "because folks are going to need ambulance care regardless of whether their insurance company will cover it." She said the state's proposal would leave those paying for health coverage with the burden of the new price. "None of us like our insurance rates to move," Republican state Sen. Mark Noland said during a legislative meeting as a committee tabled the bill. He equated the proposed minimum to a mandate that could lead to people having to pay more for health coverage for an important but nonetheless niche service. Colorado's governor was similarly focused on premiums. Polis said in his veto letter that the legislation would have raised premiums between 73 cents and $2.15 per member per month. "I agree that filling this gap in enforcement is crucial to saving people money on health care," he wrote. "However, those cost savings are outweighed in my view by the premium increases." Isabel Cruz, policy director at the Colorado Consumer Health Initiative, which supported the bill, said that even if premiums did rise, Coloradans might be OK with the change. After all, she said, they'd be trading the threat of a big ambulance bill for the price of half a cup of coffee per month. Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
Business Wire
24-06-2025
- Business
- Business Wire
Hospitals and Health Systems Can Find Help With Price Transparency Compliance and Pricing Optimization With Kodiak Solutions' Strategic Pricing Methodology
INDIANAPOLIS--(BUSINESS WIRE)--Kodiak Solutions offers hospitals a proven, technology-driven strategic pricing methodology to set prices across thousands of procedures and services to meet regulatory and market pressures. 'Hospitals have never faced more regulatory scrutiny on price transparency, and compliance requires public disclosure of prices... raising the stakes for making consistent, defensible prices.' --Tracey Coyne, Vice President, Kodiak Solutions Share Hospitals and health systems must comply with price transparency requirements under multiple federal laws or regulations, including the No Surprises Act, new inpatient and outpatient Medicare prospective payment regulations, and tightening rules from the Centers for Medicare & Medicaid Services (CMS). The business pressures of pricing are no less intense: Pricing strategy can affect an additional 0.25% to 0.5% of net revenue for health systems. 'The impact of pricing on revenue can make all the difference in a time of incredibly tight margins,' said Tracey Coyne, Vice President, Finance and Reimbursement Strategic Pricing Lead. 'Hospitals have never faced more regulatory scrutiny on price transparency, and compliance requires public disclosure of prices in most cases, raising the stakes for making consistent, defensible prices across thousands of procedures and services.' Kodiak Solutions experts partner with hospital and health system management teams to co-develop custom versions of Kodiak's strategic pricing methodology. The customized recommendations also are based on a provider organization's existing financial data as analyzed by Kodiak Revenue Cycle Analytics platform. The optimized, data-driven pricing strategy that results offers health systems: Improved rates based on the organization's market position, fee schedules, and payor mix; Standardized pricing within and across the organization's service lines, departments and care settings; Market-based pricing to attract and retain patients; and Consistent pricing that is defensible when publishing to the community. Hospitals and health systems that work with the Kodiak Solutions strategic pricing team receive an electronic upload of new prices, reports on changes in gross and net revenue by facility, department and payor, a price inconsistency report, and more. Kodiak Solutions recently hosted a webinar on pricing transparency, No Surprises Act compliance and other topics related to strategic pricing that is available online. To discuss Kodiak Solutions' strategic pricing methodology, call (463) 270-8252 to schedule an appointment with Coyne. About Kodiak Solutions Kodiak Solutions is a leading technology and tech-enabled services company that simplifies complex business problems for healthcare provider organizations. For nearly two decades as a part of Crowe LLP, Kodiak created and developed our proprietary net revenue reporting solution, Revenue Cycle Analytics. Kodiak also provides a broad suite of software and services in support of CFOs looking for solutions in financial reporting, reimbursement, revenue cycle, risk and compliance, and unclaimed property. Kodiak's 450 employees engage with more than 2,100 hospitals and 300,000 practice-based physicians, across all 50 states, and serve as the unclaimed property outsourcing provider of choice for more than 2,000 companies. To learn more, visit our website.
Associated Press
11-06-2025
- Business
- Associated Press
Introducing CollectionPro: Transforming ARs and Out-of-Network Medical Claims Recovery with End-to-End Solutions
End-to-end AR & OON claims recovery with no upfront cost, legal expertise, & full NSA compliance. NEW YORK, NY, UNITED STATES, June 11, 2025 / / -- In a healthcare landscape where reimbursement delays and administrative complexities are rampant, CollectionPro Services LLC. emerges as a leading force in Accounts Receivable management and Out-of-Network (OON) claims recovery while delivering industry-defining solutions that maximize revenue, reduce operational burden, and empower providers through streamlined support. Focused on solving clients' AR problems for years, CollectionPro is now committed to revolutionize how providers recover revenue from unpaid and underpaid insurance claims, especially from Out-of-Network claims, by facilitating Independent Dispute Resolution (IDR) under the No Surprises Act (NSA) of 2022. From Emergency Room physicians and trauma surgeons to anesthesiologists, radiologists, and specialty pharmacists, the platform is designed for specialists who frequently deliver care under time-sensitive, critical conditions—often outside standard in-network arrangements. ' Out-of-Network collections shouldn't be complicated. Our mission is simple: help providers get paid what they're rightfully owed—with no upfront fees, no hidden costs, and no stress,' said Maverick Johnson, the spokesperson for CollectionPro. CollectionPro's Key Differentiators: • CollectionPro handles everything — End-to-end support with collections, from identifying unpaid claims to making fresh appeals and insurer negotiations—so practices can focus on patient-care. • No arbitration or advance fees – Providers have to pay nothing upfront as CollectionPro advances all costs ($115 in administrative fees + up to $1,200 in arbitration fees), refundable only if the case is won by the provider. • Expert support – Every arbitration is handled by an in-house, multi-state licensed attorney, specializing in NSA and IDR cases with 10,000+ cases under his belt. • Low contingency-based pricing – Only 10% for high-impact specialties like Anesthesia, ER Surgery, Gastroenterology, Cardiology, Plastic & Reconstructive Surgery, and Air Ambulance, and 20% for all other specialties. • Multi-payer experience – Be it federal or state-level, commercial or managed care, from complex California's AB-72 or Knox Keene acts to Texas and Florida's state-specific laws, providers are covered for all. • Collecting from aging AR – Powerful support in collecting from OON claims dated post-Jan 1, 2022, even if previously denied or underpaid. • Real-time reporting – CollectionPro excels at keeping their clients informed with customized reports, available daily, weekly, or on-demand. • Free account manager – A dedicated account manager is assigned to every client, at no extra cost, available for any update 9am–5pm EST daily. • Risk-free engagement – With no setup fees, no binding contracts, easy exit options and a 'pay if you win' engagement model, CollectionPro's services are available at zero risk to its clients. Comprehensive NSA Compliance Support CollectionPro is at the forefront of No Surprises Act compliance, helping providers navigate the legal and administrative complexities introduced by the legislation. Services include: • OON Revenue Recovery & IDR Filing • Good Faith Estimate (GFE) Management • Advance Notice & Consent Templates • Payment Dispute Negotiation • Provider Education & NSA Compliance Tools Built for Providers. Trusted by Specialists. Whether it involves an orthopedic surgeon, a neonatologist, a gynecologist, or an intensivist, CollectionPro customizes its solutions to meet every physician's unique needs. Clients benefit from: • Reduced rejection rates • Fewer write-offs and improved collections • Elimination of tedious paperwork • Increased reimbursement transparency • Streamlined claim submission and resolution From emergency services to ancillary specialists and ambulatory surgical centers, CollectionPro is committed to removing the stress of unpaid claims — and turning lost revenue into recovered revenue. About CollectionPro: CollectionPro Services LLC is a New York-based firm specializing in revenue collection solutions for healthcare providers across the United States. Founded to address the challenges of securing fair reimbursements from payers, while offering expert assistance in Out-of-Network (OON) claims resolution, No Surprises Act (NSA) arbitration services, and comprehensive Accounts Receivable (AR) and claims management services, their services include managing A/R from payers like Medicare and commercial insurers, addressing denials, underpayments, and long adjudication cycles to optimize collections. With a multi-state licensed attorney and dedicated resources, CollectionPro experts have been consistently ensuring better ROI for many leading names in the healthcare industry. CollectionPro's advance all arbitration and administrative fee and has no upfront costs as they believe in 'we get paid when you get paid'. CollectionPro today is the preferred partner for practices and facilities trying to navigate the complex world of OON claims recovery and payer negotiations. Maverick Johnson CollectionPro Services LLC +1 212-243-3516 email us here Visit us on social media: LinkedIn YouTube X Legal Disclaimer: EIN Presswire provides this news content 'as is' without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.
Yahoo
04-06-2025
- Business
- Yahoo
HaloMD Vows to Defend Providers and the Federal IDR Framework Against Blue Cross Lawsuit
DALLAS, June 4, 2025 /PRNewswire/ -- HaloMD, the nation's prominent health‑technology company empowering healthcare providers to secure fair payment through the federal Independent Dispute Resolution (IDR) process, announced today that it will fight "to the full extent of the law" against a baseless lawsuit filed by Blue Cross Blue Shield Healthcare Plan of Georgia (BCBSGA) in the U.S. District Court for the Northern District of Georgia on May 27, 2025. "After years of systematically underpaying physicians and severely compressing reimbursement rates, BCBSGA has resorted to a courtroom smear campaign orchestrated to intimidate healthcare providers and to challenge rules and regulations of the very system Congress established to ensure fairness and protection for patients and providers," stated Alla LaRoque, President of HaloMD. "HaloMD will not stand by while a dominant insurer tries to suppress the evidence‑based advocacy that is finally achieving parity for physicians." The lawsuit arrives as national attention centers on the No Surprises Act (NSA)—landmark legislation that protects patients from surprise medical bills and grants clinicians a federally protected Independent Dispute Resolution (IDR) structure to contest insurers' unfairly low reimbursements. Regulated and implemented by the Centers for Medicare & Medicaid Services (CMS), the IDR process relies on certified Independent Dispute Resolution Entities (IDREs) to issue legally-binding, impartial arbitration awards. HaloMD has emerged as the industry's best‑in‑class technology partner—and a lifeline—for physician groups that lack the scale, resources, or in‑house expertise to navigate the complex IDR process and reclaim revenue lost to chronic underpayment. For many small and rural practices, HaloMD is the difference between keeping the lights on and closing their doors. HaloMD's platform levels the playing field, arming every provider—regardless of size—with the data, technology, and regulatory savvy needed to secure fair, timely payments. Lawsuit attacks providers and the arbitration system itself BCBSGA's filing does not merely target emergency physicians who have long suffered systemic underpayment or no payment at all; it directly challenges certified IDREs and the entire IDR framework. If successful, the suit would: Erode statutory safeguards, compliance with rules and regulations, authority of impartial arbitrators and balance in the process of dispute resolution; Disrupt patient access to emergency care by jeopardizing sustainability of medical practices; Set a dangerous precedent allowing insurers to litigate away federal consumer‑protection laws and processes After decades of setting reimbursement rates unilaterally, insurers are now confronting a neutral, factor‑driven arbitration process where they no longer hold the upper hand. As IDR rulings uphold fair and reasonable payments, BCBSGA has resorted to baseless litigation to regain an advantage it can no longer command. Put plainly, this payor is attacking the process because it is losing in IDR. "This is not a good‑faith legal dispute—it is a calculated strike aimed at collapsing the IDR infrastructure so insurers can return to unilateral price‑setting," added LaRoque. Timing underscores insurer's intent BCBSGA filed its lawsuit just one day before the Centers for Medicare & Medicaid Services (CMS) released public‑use data confirming that more and more emergency physicians—pushed into IDR after being paid pennies on the dollar—are finally recouping the reimbursements they were always entitled to with HaloMD's support. Next steps HaloMD is prepared to vigorously defend itself in this litigation in a manner that will highlight the lawsuit's meritless nature. "Our mission is bigger than any single lawsuit," LaRoque said. "We exist to safeguard the financial viability of medical practices so they can focus on saving lives—not fighting payors." Media Contact Press Inquiries: HaloMD Communications, View original content to download multimedia: SOURCE HaloMD Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
04-06-2025
- Business
- Yahoo
HaloMD Vows to Defend Providers and the Federal IDR Framework Against Blue Cross Lawsuit
DALLAS, June 4, 2025 /PRNewswire/ -- HaloMD, the nation's prominent health‑technology company empowering healthcare providers to secure fair payment through the federal Independent Dispute Resolution (IDR) process, announced today that it will fight "to the full extent of the law" against a baseless lawsuit filed by Blue Cross Blue Shield Healthcare Plan of Georgia (BCBSGA) in the U.S. District Court for the Northern District of Georgia on May 27, 2025. "After years of systematically underpaying physicians and severely compressing reimbursement rates, BCBSGA has resorted to a courtroom smear campaign orchestrated to intimidate healthcare providers and to challenge rules and regulations of the very system Congress established to ensure fairness and protection for patients and providers," stated Alla LaRoque, President of HaloMD. "HaloMD will not stand by while a dominant insurer tries to suppress the evidence‑based advocacy that is finally achieving parity for physicians." The lawsuit arrives as national attention centers on the No Surprises Act (NSA)—landmark legislation that protects patients from surprise medical bills and grants clinicians a federally protected Independent Dispute Resolution (IDR) structure to contest insurers' unfairly low reimbursements. Regulated and implemented by the Centers for Medicare & Medicaid Services (CMS), the IDR process relies on certified Independent Dispute Resolution Entities (IDREs) to issue legally-binding, impartial arbitration awards. HaloMD has emerged as the industry's best‑in‑class technology partner—and a lifeline—for physician groups that lack the scale, resources, or in‑house expertise to navigate the complex IDR process and reclaim revenue lost to chronic underpayment. For many small and rural practices, HaloMD is the difference between keeping the lights on and closing their doors. HaloMD's platform levels the playing field, arming every provider—regardless of size—with the data, technology, and regulatory savvy needed to secure fair, timely payments. Lawsuit attacks providers and the arbitration system itself BCBSGA's filing does not merely target emergency physicians who have long suffered systemic underpayment or no payment at all; it directly challenges certified IDREs and the entire IDR framework. If successful, the suit would: Erode statutory safeguards, compliance with rules and regulations, authority of impartial arbitrators and balance in the process of dispute resolution; Disrupt patient access to emergency care by jeopardizing sustainability of medical practices; Set a dangerous precedent allowing insurers to litigate away federal consumer‑protection laws and processes After decades of setting reimbursement rates unilaterally, insurers are now confronting a neutral, factor‑driven arbitration process where they no longer hold the upper hand. As IDR rulings uphold fair and reasonable payments, BCBSGA has resorted to baseless litigation to regain an advantage it can no longer command. Put plainly, this payor is attacking the process because it is losing in IDR. "This is not a good‑faith legal dispute—it is a calculated strike aimed at collapsing the IDR infrastructure so insurers can return to unilateral price‑setting," added LaRoque. Timing underscores insurer's intent BCBSGA filed its lawsuit just one day before the Centers for Medicare & Medicaid Services (CMS) released public‑use data confirming that more and more emergency physicians—pushed into IDR after being paid pennies on the dollar—are finally recouping the reimbursements they were always entitled to with HaloMD's support. Next steps HaloMD is prepared to vigorously defend itself in this litigation in a manner that will highlight the lawsuit's meritless nature. "Our mission is bigger than any single lawsuit," LaRoque said. "We exist to safeguard the financial viability of medical practices so they can focus on saving lives—not fighting payors." Media Contact Press Inquiries: HaloMD Communications, View original content to download multimedia: SOURCE HaloMD Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
