Payers open low and wait. Most practices — and most billing companies — accept offer one and move on. We don't. We negotiate every OON case and file federal IDR when negotiations stall. The difference can be 5–7× the initial payer offer.
Request a Free OON AuditThe gap between offer 1 and the final settlement was not created by new clinical evidence. It was created by knowing the process, understanding the leverage points, and refusing to stop at the number the payer wanted the practice to accept.
The No Surprises Act (effective January 2022) created a federal Independent Dispute Resolution process — a formal arbitration mechanism that gives providers a legitimate pathway to contest payer offers. A certified arbitrator reviews the dispute against the Qualifying Payment Amount benchmark.
Practices with proper documentation and a clear negotiation record have used IDR to recover multiples of initial payer offers. Most practices have never filed one. We have.
Major insurers use MultiPlan to present below-market offers as if they were negotiated settlements. They are not. We identify these and challenge them.
When payer negotiations stall, we submit the dispute to federal IDR. The process is formal, documented, and consistently produces better outcomes than accepting the initial offer.
SCS implants, RFA, SI joint fusions — these procedures generate large OON exposure and require specialty-specific negotiation knowledge.
Strong OON outcomes start with the initial claim. We build the documentation record at submission so the negotiation position is defensible from the start.
We'll review your out-of-network claim history and identify cases where the accepted payment was materially below what was recoverable. No obligation — just a clear picture of what was left behind.
Request Your Free OON Review