Latest news with #NoSurprisesAct
Yahoo
6 days ago
- 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
6 days ago
- 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
18-05-2025
- Health
- Yahoo
Get a Surprise Medical Bill You Can't Pay? 6 Resources That Can Help
Did you receive a surprise medical bill? If so, you're not alone. According to KFF, Americans owe an estimated $220 billion in medical debt, which can be seriously detrimental to their overall finances. Read Next: Check Out: If you find yourself with a surprise medical bill, you have options. Here are some top resources to help you pay your medical bills. The No Surprises Act of 2022 limits how much you have to pay for out-of-network providers or facilities. It is defined to ensure you're paying closer to what you'd pay if you'd received services in your network, according to the Consumer Financial Protection Bureau. If you're uninsured or self-pay for insurance, you should get a 'good faith' estimate when you first schedule care with your provider. If the amount you're billed is $400 higher than the estimate showed, you may be able to dispute it. To do so, contact the No Surprises help desk or file a complaint online. Learn More: The government has quite a few programs that can help you pay your medical bills. These include Medicare, Medicaid and the Children's Health Insurance Program. Eligibility mostly depends on your income, but it never hurts to research your options. If you're dealing with a hefty medical bill that your insurance doesn't cover, these options from could help: Medicare Savings Programs that help with Medicare Parts A and B Medicare Extra Help for help with prescription drug costs Local or state charity care programs that can offset the cost of medical treatment State social service agency that can give you referrals to better or more affordable healthcare. Did you know you might be able to get on a payment plan rather than pay the entire bill at once? 'Most providers will allow you to spread the balance over time, often interest-free so don't be afraid to ask about this,' said Linda Jensen, a chartered financial consultant, chartered life underwriter and certified financial fiduciary with Heart Financial Group. 'Make sure you can afford the monthly amount, defaulting on a medical payment plan can hurt your credit if the debt is turned over to a collection agency.' When you get an unexpected medical bill, one of the first things you should do is review it to make sure you're getting billed only for treatment or services you actually received. After all, billing errors can happen. You can request an itemized bill. Once you have that, cross-reference it with your insurance plan's explanation of benefits to make sure everything looks in order. If it doesn't, reach out to your provider and find out what's going on. Know that you might be able to lower how much you owe even if the amount is correct. According to Jensen, you may be able to get one of the following: Discount for prompt payment (best for those who have the cash on hand) Cash rate rather than the billed rate Balance reduction or forgiveness (best for those experiencing legitimate financial hardship). 'Always get any agreement in writing before making payments,' Jensen said. By law, nonprofit hospitals must offer a financial assistance policy (FAP), per the IRS. Reach out to the hospital where you received treatment and request a financial assistance application. You may be required to submit documents verifying your income or financial hardship. Eligibility for these programs depends on factors like income, financial hardship and household size. In some cases, the hospital will offer financial assistance even after you've received a bill — so long as you qualify. Certain nonprofits, like the Patient Advocate Foundation, exist to help people with their healthcare and medical bills. If you receive a surprise bill, consider contacting one of these organizations to see if they can help. The Patient Advocate Foundation, for example, has an independent division that provides grants to patients who meet medical and financial criteria. More From GOBankingRates 5 Luxury Cars That Will Have Massive Price Drops in Spring 2025 8 Items To Stock Up on Now in Case of Tariff-Induced Product Shortages 8 Common Mistakes Retirees Make With Their Social Security Checks 10 Genius Things Warren Buffett Says To Do With Your Money Sources KFF, 'What resources are available for privately insured patients who get surprise balance bills?' Consumer Financial Protection Bureau, 'What is a 'surprise medical bill' and what should I know about the No Surprises Act?' 'How to get help with medical bills.' Linda Jensen, Heart Financial Group IRS, 'Financial assistance policy and emergency medical care policy – Section 501(r)(4).' Patient Advocate Foundation, 'Financial Aid Funds.' This article originally appeared on Get a Surprise Medical Bill You Can't Pay? 6 Resources That Can Help 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
18-05-2025
- Health
- Yahoo
Get a Surprise Medical Bill You Can't Pay? 6 Resources That Can Help
Did you receive a surprise medical bill? If so, you're not alone. According to KFF, Americans owe an estimated $220 billion in medical debt, which can be seriously detrimental to their overall finances. Read Next: Check Out: If you find yourself with a surprise medical bill, you have options. Here are some top resources to help you pay your medical bills. The No Surprises Act of 2022 limits how much you have to pay for out-of-network providers or facilities. It is defined to ensure you're paying closer to what you'd pay if you'd received services in your network, according to the Consumer Financial Protection Bureau. If you're uninsured or self-pay for insurance, you should get a 'good faith' estimate when you first schedule care with your provider. If the amount you're billed is $400 higher than the estimate showed, you may be able to dispute it. To do so, contact the No Surprises help desk or file a complaint online. Learn More: The government has quite a few programs that can help you pay your medical bills. These include Medicare, Medicaid and the Children's Health Insurance Program. Eligibility mostly depends on your income, but it never hurts to research your options. If you're dealing with a hefty medical bill that your insurance doesn't cover, these options from could help: Medicare Savings Programs that help with Medicare Parts A and B Medicare Extra Help for help with prescription drug costs Local or state charity care programs that can offset the cost of medical treatment State social service agency that can give you referrals to better or more affordable healthcare. Did you know you might be able to get on a payment plan rather than pay the entire bill at once? 'Most providers will allow you to spread the balance over time, often interest-free so don't be afraid to ask about this,' said Linda Jensen, a chartered financial consultant, chartered life underwriter and certified financial fiduciary with Heart Financial Group. 'Make sure you can afford the monthly amount, defaulting on a medical payment plan can hurt your credit if the debt is turned over to a collection agency.' When you get an unexpected medical bill, one of the first things you should do is review it to make sure you're getting billed only for treatment or services you actually received. After all, billing errors can happen. You can request an itemized bill. Once you have that, cross-reference it with your insurance plan's explanation of benefits to make sure everything looks in order. If it doesn't, reach out to your provider and find out what's going on. Know that you might be able to lower how much you owe even if the amount is correct. According to Jensen, you may be able to get one of the following: Discount for prompt payment (best for those who have the cash on hand) Cash rate rather than the billed rate Balance reduction or forgiveness (best for those experiencing legitimate financial hardship). 'Always get any agreement in writing before making payments,' Jensen said. By law, nonprofit hospitals must offer a financial assistance policy (FAP), per the IRS. Reach out to the hospital where you received treatment and request a financial assistance application. You may be required to submit documents verifying your income or financial hardship. Eligibility for these programs depends on factors like income, financial hardship and household size. In some cases, the hospital will offer financial assistance even after you've received a bill — so long as you qualify. Certain nonprofits, like the Patient Advocate Foundation, exist to help people with their healthcare and medical bills. If you receive a surprise bill, consider contacting one of these organizations to see if they can help. The Patient Advocate Foundation, for example, has an independent division that provides grants to patients who meet medical and financial criteria. More From GOBankingRates 5 Luxury Cars That Will Have Massive Price Drops in Spring 2025 8 Items To Stock Up on Now in Case of Tariff-Induced Product Shortages 8 Common Mistakes Retirees Make With Their Social Security Checks 10 Genius Things Warren Buffett Says To Do With Your Money Sources KFF, 'What resources are available for privately insured patients who get surprise balance bills?' Consumer Financial Protection Bureau, 'What is a 'surprise medical bill' and what should I know about the No Surprises Act?' 'How to get help with medical bills.' Linda Jensen, Heart Financial Group IRS, 'Financial assistance policy and emergency medical care policy – Section 501(r)(4).' Patient Advocate Foundation, 'Financial Aid Funds.' This article originally appeared on Get a Surprise Medical Bill You Can't Pay? 6 Resources That Can Help
CBS News
06-05-2025
- Health
- CBS News
People feeling sticker shock over high ambulance fees
People are feeling the pain of sticker shock over large ambulance bills. Kathleen Knotek lives in Whitehall with her cat, which inadvertently caused an expensive fall. "I just sat down on the floor and called the ambulance service, and unfortunately, it wasn't the same group that usually comes here," Knotek said. She pays a subscription to Medical Rescue Team South Authority, but Baldwin EMS answered her 911 call that day. "When they came in, they asked me a bunch of questions about what happened, took my blood pressure," Knotek said. She did not need to race off to the hospital, and first responders got her back on her feet after evaluating her. But the $891 bill shocked her. Her niece, Martha Brahm, called Baldwin EMS and negotiated a discount. Since Knotek pays a yearly subscription to a neighboring ambulance service, Baldwin EMS agreed to honor that. "Since the insurance didn't pay anything, then they said the charge would be 50 percent of the $891, so $445," Brahm said. KDKA Investigates learned that in Pennsylvania, the average ambulance ride costs $1,442 for basic life support and $1,580 for advanced life support. Some charge a flat $200 fee for what are called "lifts," but not all do that. Baldwin EMS Chief Todd Plunkett said, despite his $6.5 million budget, he is still $400,000 to $500,000 in the red every year. "Usually, the insurance companies do not pay us the full amount for the care and the transportation to the hospital," the chief said. "On a $1,000 bill, we might get $300. We might get $200." He said insurance companies Monday-morning quarterback every call after the fact. "No other business or profession would come to your home, come to your place of business, provide a service expecting no pay at the end or partial pay or percentage pay without some type of agreement," Plunkett said. Because there's no blanket agreement in the industry, every ambulance company is trying different things to stay afloat. "A lot of the charges vary from community to community, and it's not very transparent," said Patricia Kelmar, senior director of healthcare campaigns for Public Interest Research Group. Kelmar said people are now protected from surprise medical bills thanks to Congress' No Surprises Act, but no one is protected from surprise ambulance bills. She said the issue came up, but Congress chose not to include those protections for now, and instead created a committee to look deeper into it. "The committee was appointed, and I served as the consumer patient representative on the committee," Kelmar said. "We put together recommendations that were sent to Congress in September of 2024, and we have yet to see action by Congress." For Kelmar, until Pennsylvania can come up with a consistent pricing system, she suggests reading the language closely before paying for a subscription to any local ambulance fleet. "It's a buyer-beware situation," Kelmar said. "We don't really recommend them because they are so minimally useful." However, she said subscriptions could help some people looking for regular transportation back and forth to somewhere other than a hospital, like a nursing home. Chief Plukett said his ambulance company cannot provide those types of rides, but does cover 100 percent of the bills for subscription members. "If you're a subscriber, you're a subscriber," he said. "Our subscription rates sometimes go up to $95, $105 a year. You divide that over 12 months, I think that's a fair amount." Knotek fears her sticker shock could cause her to hesitate next time she needs help. "That's kind of asking a lot from a senior citizen on a fixed income," Knotek said. "This is a public health emergency," Kelmar said. "People are making unwise medical decisions because of the cost." Kelmar says the good news is that there are laws on the books in other states, so Pennsylvania could look at the best laws and implement those.
