The No Surprises Act (NSA) is a powerful tool for securing fair reimbursement, but its complexity often leads to misinterpretation—something insurers commonly exploit. Many providers unknowingly leave money on the table by assuming certain claims don’t qualify for arbitration when they actually do. Emergency services remain protected under the NSA even after a patient is stabilized or transferred, ensuring that medically necessary post-stabilization care is eligible. Ancillary services provided by out-of-network specialists in in-network facilities are also covered, despite frequent insurer pushback. Air ambulance and emergency transport claims are another area where confusion happens, yet these services are explicitly included under the law because patients have no control over emergency transport providers. Additional uncertainty arises when claims fall under both federal NSA provisions and state surprise billing laws, causing some practices to avoid arbitration altogether. Even care delivered in hybrid or non-traditional settings—such as freestanding emergency centers, urgent care tied to emergency episodes, or telemedicine consultations—may qualify if it meets the NSA’s emergency care definitions. By understanding where misinterpretations commonly occur, healthcare providers can challenge incorrect denials, pursue arbitration with confidence, and ensure they recover the payments they’re rightfully owed.
source: https://callagyrecovery.com/no-surprises-act-claims-often-mistaken-as-ineligible/
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