The “No Surprises Act” (NSA) limits the amount that health plan participants pay for out-of-network (OON) medical services in specific situations when participants don’t have control over their treating provider. Pursuant to the NSA, medical providers and health plans participate in an “independent dispute resolution” (IDR) process to determine the amount to be paid by the health plan to the provider for such OON services. This article provides an overview of the issues encountered by health plan sponsors and fiduciaries when navigating the IDR process under the NSA.
