How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

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 their latest post for the Commonwealth Fund, CHIR experts Jack Hoadley and Maanasa Kona assess the implementation of an IDR process in nine states. You can read the full post here.

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.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.