Sending A Patient Statement While In IDR Process

Quest ion:

We are planning to initiate the IDRprocess with a payer after the open negotiation was unsuccessful Remit from payer is showing the patient's responsibility at $4500 (coinsurance and deductible amounts). Is it appropriate to send patient statement while we are in the IDR process?It is their cost share amount per the payer so just wanting to make sure we are good to bill patient while we wait for the IDRprocess to make a decision which I am hearing is quite back logged.

Answ er:

Yes, the patient can be billed for any cost sharing amounts while the account is in arbitration

We encourage you to confirm that the $4,500 patient liability was accurately applied by the plan as required by the NSA.

In general, for emergency services furnished by a non-participating provider or a non-participating emergency facility, and for non-emergency services furnished by nonparticipating providers with respect to a visit to a participating health care facility, cost sharing is calculated as if the total amount that would have been charged for the services by a participating emergency facility or participating provider were equal to the recognized amount for the services

If an All-Payer Model Agreement or specified state law applies, the plan or issuer must calculate cost sharing for out-of-network services that are subject to the No Surprises Act (based on the amount determined by the All-Payer Model Agreement or specified state law.