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Surprise Billing

In late 2020, Congress passed the No Surprises Act which aimed to fix the problem of unanticipated medical bills and, for the first time at the national level, remove patients from the middle of out-of-network billing disputes. The newly passed law establishes an independent dispute resolution (IDR) process that permits batching of claims and includes no monetary threshold to access IDR.

AAOS and other physician groups advocated for these provisions, along with language that requires the arbiter to equally consider a range of factors with the insurers' median in-network rate when adjudicating a dispute; including, but not limited to the complexity of services, market share, level of training, experience, and quality and outcome measurements, demonstrations of previous efforts to enter into network agreements and previously contracted rates.

In its attempt to implement the law and IDR process, the Administration crafted rules that disregard congressional intent and are inconsistent with the carefully negotiated statutory language. Even worse, they give priority to the insurer-formulated median in-network rate over all other factors which may lead to sweeping reductions in both out-of-network and in-network reimbursement over time.

AAOS is demanding that the Administration correctly implement the No Surprises Act. AAOS has signed onto an amicus brief that has been filed with the United States District Court for the District of Columbia in support of the American Medical Association's lawsuit against the Administation for failing to follow congressional intent.