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Surprise Billing

ArentFox Schiff is a coast-to-coast leader in advising health care providers on surprise billing dispute resolution and regulatory compliance matters. We advise clients on out-of-network reimbursement disputes under the federal No Surprises Act and state law surprise billing protections. To help accomplish our clients’ goals, our team mobilizes an impressive array of litigators, regulatory attorneys, and issue specialists to provide a cutting-edge understanding of all issues arising in this developing area of law.

Our Surprise Billing Focus

We operate at the forefront of a new and emergent area of the law. In tandem with our ERISA and Managed Care team, as well as our Health Care and Complex Litigation practice groups, we bring to bear a broad and deep knowledge base that is simply not found in most law firms. Whether advising on a specific phase of the process for clients who file billing disputes in-house, or handling the entire surprise billing arbitration process from start to finish for clients, our team offers an expansive and customizable array of strategic options to meet even the most nuanced of our clients’ surprise billing needs. We have also represented some of the nation’s leading professional associations in all of the major challenges to the government’s regulations implementing the No Surprises Act,  including filing amicus briefs explaining the adverse effects of those regulations on health care providers and on patients’ access to quality health care.

At every stage, we assist with our clients’ surprise billing needs – from advising on regulatory and compliance issues under state and federal surprise billing regimes, to conducting open negotiations with payers, to initiating and prosecuting arbitration claims. Simply put, our unique experience running these processes for clients helps us put our clients in the best position to prevail in surprise billing disputes.

Read Our Complete No Surprises Act Analysis

What We Do

We work with health care providers who are experiencing out-of-network reimbursement disputes, the resolution of which is subject to either state or federal surprise billing laws. Our clients, large and small health care providers of all types, rely on us for strategic advice and insight to get the most out of the surprise billing laws while focusing on broader strategy and goals. We are currently assisting clients based in more than more than a dozen states with surprise billing issues.

In this new and evolving area, we regularly handle out-of-network surprise billing reimbursement disputes on both the state and federal level. Our industry-based approach enables us to respond to every tactic our adversaries employ, and we are frequently adverse to the largest commercial payers and health insurance carriers.  Simultaneously, we provide crucial strategic and regulatory advice to ensure that our clients remain in compliance with the complex and nuanced statutes and regulations in this quickly evolving area.

How We Help

Our recent engagements on behalf of health care providers have included:

  • Successfully challenging the out-of-network payment rates for a high volume of arbitration claims submitted to the federal arbitration process on behalf of anesthesia providers.
  • Teeing up for decisions in arbitration claims under state-based surprise billing processes run by state Departments of Insurance.
  • Advising providers on compliance with state and federal surprise billing regimes, and advising on the arbitration process under the federal statute.
  • Assisting with network and non-network negotiations for our provider clients experiencing out-of-network reimbursement issues.
  • Filing amicus briefs on behalf of medical associations in cases challenging the federal regulations implementing the No Surprises Act. 

Our Team

Our surprise billing team boasts a roster of talented litigators and regulatory attorneys whose strategic capabilities enable us to steer matters through all phases of the surprise billing life cycle — from regulatory compliance prior to claim initiation, to every stage of dispute resolution proceedings on both the federal and state level.

Our experienced Health Care attorneys are adept at tackling the regulatory, compliance, reimbursement, coding, and coverage issues spanning this cutting-edge area. In addition to our legal counselors, our team is complemented by dedicated non-lawyer specialists, who enable us to handle even large-volume surprise billing disputes.