...intent in their rulemaking by ensuring a balanced process to settle payment disputes between #health plans and providers, but also ensure an #IDR process that captures the unique circumstances of each billing dispute and does not cause any single piece of information to be...
☑️ Everyone agrees to take #patients out of the dispute b/w #insurer & #doctor.
☑️ Everyone agrees to let the 2 parties negotiate the bills if the initial...
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payment is deemed to be unacceptable.
☑️ Everyone agrees that there must be a fall back to a neutral third party (i.e., an #IDR entity).
⭐️BUT, what is disputed is whether this IDR will be a fair process where both sides can equally make their case for what is the most...
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appropriate amount for that non-contracted service OR whether the IDR will be rigged and so unfair that the insurer will always win the dispute.
Many IDR proposals, sadly, are unfair, pointing the IDR to primarily consider the contracted rates #health insurers make up...
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