With providers winning 82% of settled cases in Q3 and Q4 2023, according to the CMS report, the incentive to continue filing a high volume of disputes is apparent.
The issue is how to determine what an out-of-network rate should be. One side wants to be paid more while the other side wants to pay less.
If consumers would ask for prices up front there would never be a balance bill.
See article here: The courts continue to favor providers in No Surprises Act litigation, this time at the appellate level | HFMA
