Who we serve

Provider groups whose out-of-network care the federal process covers.

The No Surprises Act protects patients from surprise bills in three situations. When a plan underpays for that care, the federal dispute process is how a provider group asks for a fair payment. These are the groups we work for.

Emergency care

Emergency services from out-of-network providers or facilities, including care after the patient is stabilized.

Emergency medicine groups
Emergency departments, including freestanding emergency departments
Post-stabilization services

Hospital-based specialties at in-network facilities

Non-emergency care from out-of-network clinicians at in-network hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgical centers. For these ancillary services, and for any service no in-network clinician at the facility could provide, patients cannot be asked to waive their protections.

Anesthesiology
Radiology
Pathology
Neonatology
Hospitalists
Intensivists
Assistant surgeons
Diagnostic services, including laboratory

Air ambulance

Out-of-network air ambulance services.

Air ambulance providers

What the federal process does not cover

Medicare, Medicaid, TRICARE, VA, Indian Health Service and other public programs.
Claims governed by a state surprise-billing law. Those go to the state’s own process, never the federal one.
Services outside the No Surprises Act protections.
The same services against the same plan during a cooling-off period. Those claims wait and are filed when the window opens.

Our screen catches each of these before any fee is spent, and you see the reason for every claim it rules out.

State law and plan type

Some states have their own surprise-billing laws. In those states, fully insured plans usually follow the state process, while self-funded employer plans usually stay federal unless the plan has opted in to the state process.