Men at business meeting The knowledge that balance billing is the only option available to the provider should they fail to negotiate with the payer, was a key incentive when it came to negotiating out-of-network (OON) balances with providers.

Editor’s note: This is the second installment of a three-part deep-dive dive into the nuances of this much-heralded piece of health care reform. Catch up on the first one here.

In direct opposition to the philosophy underpinning reference-based pricing (RBP), the No Surprises Act (NSA) does not reference any objective payment standard. In other words, there is no universally agreed-upon standard the parties can use in determining a fair payment. It should be noted that setting these payments exclusively via arbitration is a departure from initial proposals advanced by the Senate Health, Education, Labor, and Pensions Committee and the House Energy and Commerce Committee in 2019, which would have instead directly specified a “benchmark” payment rate equal to the median in-network rate for similar services. Using arbitration was a key demand of provider groups.

Complete your profile to continue reading and get FREE access to, part of your ALM digital membership.

Your access to unlimited content isn’t changing.
Once you are an ALM digital member, you’ll receive:

  • Critical information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and events.
  • Access to other award-winning ALM websites including and

Already have an account?



Join BenefitsPRO

Don’t miss crucial news and insights you need to navigate the shifting employee benefits industry. Join now!

  • Unlimited access to - your roadmap to thriving in a disrupted environment
  • Access to other award-winning ALM websites including and
  • Exclusive discounts on and ALM events.

Already have an account? Sign In Now
Join BenefitsPRO

Copyright © 2023 ALM Global, LLC. All Rights Reserved.