Out-of-network disputes involve the amount payable where no negotiated rate exists. Providers bill charges while payers pay a plan-determined amount, leaving a gap historically billed to the patient.
The No Surprises Act now limits patient exposure in defined circumstances.
Alternative Names:
OON Dispute, Non-Participating Provider Dispute
Why it Matters?
The federal independent dispute resolution process created by the No Surprises Act now resolves many of these disputes through baseball-style arbitration, where each side submits an offer and the arbitrator picks one. Volume has substantially exceeded projections, and the process itself has been subject to litigation over the factors arbitrators must weigh. For injury litigation the practical effect is on medical damages, since capped out-of-network emergency charges reduce claimed specials.
Frequently Confused with
Related terms
Frequently asked questions
How are these disputes now resolved?
What is the effect on injury litigation?
