Healthcare litigation resource

No Surprises Act resource.

A supporting resource for payors, plans, insurers, providers, and business stakeholders navigating out-of-network payment disputes, Federal Independent Dispute Resolution, and related healthcare litigation issues.

Federal framework

Payment disputes now involve administrative process as well as litigation strategy.

The No Surprises Act established federal protections against certain surprise medical bills and created a Federal Independent Dispute Resolution process for specified payment disputes between plans or issuers and providers, facilities, or air ambulance services.

Questions may involve federal and state interaction, open negotiation, eligibility, timing, offer selection, payment methodology, administrative records, preemption, contract claims, and related litigation.

Potential issues

Federal IDR does not eliminate the need for litigation judgment.

The governing pathway can depend on the service, plan, state law, contract status, procedural history, deadlines, and claims asserted.

Eligibility and timingWhether the item or service falls within the federal process and whether negotiation and initiation deadlines were satisfied.
Federal and state lawWhich payment methodology or dispute process applies and how state law interacts with the federal framework.
Administrative recordWhat information supports the offer, how submissions are framed, and what procedural defects may matter.
Related litigationContract, statutory, preemption, procedural, enforcement, or other claims outside or adjacent to Federal IDR.

This page is general information, not legal advice. Federal guidance and deadlines change; consult current official sources and counsel for a specific matter.

Direct answers

Frequently asked questions.

These answers are general information, not legal advice. The analysis of a specific matter depends on its facts, law, forum, and objectives.

What is the Federal Independent Dispute Resolution process?

Federal IDR is an administrative process created under the No Surprises Act for certain payment disputes between plans or issuers and providers, facilities, or air ambulance services after an open-negotiation period. Eligibility, timing, and procedure depend on current law and guidance.

Does the No Surprises Act replace all healthcare payment litigation?

No. Some disputes may proceed through Federal IDR, while others may be governed by state law, contract, ERISA, preemption principles, administrative procedure, or other legal theories.

Why is current official guidance important?

Federal forms, portal procedures, fees, deadlines, and guidance can change. Parties should consult current CMS and Department of Labor resources and obtain advice for the specific dispute.

Contact The Zorkin Firm

Does the dispute require senior litigation judgment?

Contact the firm to discuss the parties, general nature of the matter, business objective, and next step. Do not send confidential information before an engagement is confirmed.

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