The Healthcare Policy Podcast ®  Produced by David Introcaso
The Healthcare Policy Podcast ® Produced by David Introcaso
Nathan Martinez Discusses the Government’s Attempt to Address Out of Network Healthcare Billing
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Nathan Martinez Discusses the Government’s Attempt to Address Out of Network Healthcare Billing

Implementing the Congress's 2020 "No Surprises Act" has been a rocky road to date.

In late 2020 the Congress passed the No Surprises Act largely intended to address patient “surprise,” or out of network bills, typically the result of ER visits. Should settlement between the healthcare provider, e.g., hospital, and insurance company fail, the bill created an arbitration, termed Independent Dispute Resolution (IDR), process. To date the number of disputes going to arbitration have vastly outnumber those expected, the vast majority of provider-initiated disputes have been curiously backed by private equity, arbitration settlements takes take more than twice as long than the statutory limit, providers have been winning 75% plus of arbitrated cases and the median arbitration reimbursement is nearly four times what the Medicare program pays. 

With me to discuss the topic is Nathan Martinez, an Arizona-based healthcare claims software developer.

During this interview we mention an April 2024 New York Times article that discussed efforts by insurers to reap, or game, greater out of network reimbursement. The article is at: https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html.

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The Healthcare Policy Podcast ®  Produced by David Introcaso
The Healthcare Policy Podcast ® Produced by David Introcaso
Podcast interviews with health policy experts on timely subjects.
The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics.
An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void.
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Implementation of the Affordable Care Act
Other federal Medicare and state Medicaid health care issues
Federal health care regulatory oversight, moreover CMS and the FDA
Healthcare research
Private sector healthcare delivery reforms including access, reimbursement and quality issues
Public health issues including the social determinants of health
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