What is So Great About Being In-Network: The Misconception that the No Surprises Act Applies to Emergency Services Only - 2025 Fall Conference - HBMA Store

What is So Great About Being In-Network: The Misconception that the No Surprises Act Applies to Emergency Services Only Presented by Leslie Howard and David Boden

As presented at HBMA's 2025 Fall Conference October 6th-8th, 2025.

Medical providers face enormous challenges in balancing the delivery of patient care while navigating the onerous process to obtain fair reimbursement from payors. With the enactment of the No Surprises Act in 2022, many providers are re-examining the benefits of maintaining an in-network based model of practice. Along with the protections for patients by alleviating balance billing, NSA regulations also provide rights to the out-of-network provider and a pathway to receive direct and fair reimbursement from payors for scheduled, pre-authorized services. By initiating the Independent Dispute Resolution process, out-of network providers are now able to negotiate higher reimbursement and level the playing field by removing the decision making from the insurance payors.

This presentation will explore the impact of the No Surprises Act on the healthcare industry and the way it has changed the processes and procedures between providers and payors. We will discuss the rights afforded by the NSA regulations and examine the challenges and opportunities it presents to both in and out-of-network providers.

Learning Objectives
Course participants will be able to:

• Define the rights given to the out-of-network provider under the No Surprises Act
• Identify the current eligibility and applicability of the No Surprises Act
• Clarify common misconceptions of the No Surprises Act and when it applies
• Explain the Independent Dispute Resolution Process
• Identify the benefits and drawbacks of being in-network of out-of-network under the No Surprises Act