By Jack Hoadley and Maanasa Kona
Surprise medical bills occur when consumers receive services in emergency and sometimes non-emergency situations that – unknown to them – are from out-of-network providers. Most existing state laws address surprise bills by ensuring that patients are held harmless financially. However, there are differences in how states establish the amounts insurers pay to providers outside the network. To determine an amount, most states use either: a payment standard, an independent resolution process (IDR), or a hybrid of these two approaches.
In a separate post, available here, they, along with colleague Katie Keith, examine the experience of states that use a payment standard to govern compensation for out-of-network services.