Ep 8 - Courts Reject No Surprises Act IDR Rule – What Does This Mean for Providers and Payers?

Ep 8 - Courts Reject No Surprises Act IDR Rule – What Does This Mean for Providers and Payers?

On January 1, 2022, the No Surprises Act took effect to protect patients from surprise medical expenses, but it has created tension between payers and providers. For example, on February 23, 2022, the U.S. District Court for the Eastern District of Texas struck down the part of the interagency interim final rule implementing the “independent dispute resolution” (IDR) procedures.

When payers and out-of-network providers cannot agree on reimbursement, either party can choose to initiate an IDR. While the majority of the rule remains in effect, the changes from this case will impact health plans and the insurers that sponsor them.

These were the key themes of a recent Future Healthcare Today podcast interview with Matthew Albright, Chief Legislative Affairs Officer at Zelis, and Cate Brantley, Legislative Analyst at Zelis, who provided a deep-dive perspective on the IDR process and its impact on health payers.

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Episoder(25)

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

On the Future Healthcare Today Podcast with Lucas Hunsicker, Kristin Gasteazoro, Senior Vice President of SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice President of Brand...

24 Jul 202415min

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

In the Future Healthcare Today Podcast, hosted by Lucas Hunsicker, featuring Kristin Gasteazoro, Senior Vice President, SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice Pres...

24 Jul 202421min

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

21 Mai 202415min

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

20 Mai 202417min

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

People often turn to family, friends, and Google to make healthcare decisions and find healthcare providers. This can lead to confusion and misinformed decisions. Healthcare partners can – and should ...

18 Des 202323min

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

The Affordable Care Act, far from simplifying healthcare, has introduced many more complexities, making the jobs of HR workers even more challenging as they attempt to keep pace with the fast-changing...

17 Des 202311min

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

The Transparency in Coverage (TiC) regulations provide further clarification for the use of Machine-Readable Files (MRFs) for the health insurance industry. These rules require that healthcare plans a...

16 Des 202315min

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

The healthcare industry has seen its fair share of disruptions in the last few years. With the advent of telehealth and a renewed interest in taking charge of their healthcare, many members have inter...

15 Des 202317min

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