Original source: https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2019/05/10/the-relationship-between-network-adequacy-and-surprise-billing/
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Brookings Institution (05/10/19) Young, Christen Linke; Adler, Loren Adler; Ginsburg, Paul B.; et al..
As policymakers address the issue of surprise out-of-network statements, some are examining network adequacy regulation as a potential solution. Network adequacy criteria demand network plans to demonstrate they’ve contracted during their service region with sufficient providers. Back in 1996the National Association of Insurance Commissioners adopted its Network Adequacy Model Act, which has formed the basis for many regulation. Network adequacy policies are agnostic about which provider is in-network, and their goal is to make sure that customers can get the services their insurance plan claims to pay. Other potential strategies to curb balance billing comprise”billing regulation,” which places a minimum rate for out-of-network services which insurers are required to pay to providers, along with”contracting law,” which prohibits facility-based emergency and ancillary suppliers from billing separately to insurers or patients and instead receive payment directly from the facility…. Read More
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