Criteria on Contested Medical Bills Laid Out by Biden Agencies (1)

The Biden administration Friday issued a finalized rule stipulating that median contract rates must be the starting point for resolving payment disputes over emergency health care and when patients don’t have an opportunity to select medical providers in their insurance networks.

The final rule (RIN 1210-AB99 and 1210-AC00) clarifies what arbitrators must consider in resolving billing disputes for out-of-network emergency care, and for treatment by out-of-network providers such as anesthesiologists during procedures at facilities in a patient’s network. The rule was issued by the Labor Department, Health and Human Services Department, and Internal Revenue Service.

The payment disputes typically are ...