We have included a summary below of our Surprise Billing Disputes Collections Process. This process may differentiate based on the client’s specialty.

1. Approval for procedure: The out-of-network healthcare provider seeks approval from the insurance carrier for the procedure they are going to perform on the patient. If the procedure is defined as an “Emergency,” then the out-of-network healthcare provider is not required to seek approval before rendering life saving treatment. The definition of whether a procedure is deemed an “Emergency” is oftentimes disputed by insurance carriers. It is important to ensure you retain legal advice to determine if a procedure is deemed an “Emergency.”
2. Procedure: The out-of-network healthcare provider performs the procedure/renders services on the patient.
3. Send Bill to Carrier: The out-of-network healthcare provider sends a bill to the insurance carrier for the services rendered.
4. Insurance Carrier Reduction: The insurance carrier only approves payment for the in-network rate. This is not considered a denial.
5. Appeal letter sent by doctor: The out-of-network healthcare provider sends an appeal letter to the insurance carrier seeking the full out-of-network rate for the procedure/ services rendered.
6. Insurance Carrier Denial: Insurance Carrier denies the appeal letter sent by the out-of-network healthcare provider.
7. Claim Arbitration Process: Once you receive the denial from the Insurance Carrier, we are ready to commence formal arbitration. If the denial is under federal law, then the No Surprises Act IDR process applies. If the denial is under state law, then we look at the applicable jurisdiction since every state has its own states arbitration laws and eligibility for medical claim disputes programs that handle out-of-network claims and balance billing disputes. The following step-by-step process is a birds eye view of what MRS Law Group does for every arbitration claim:
   1. File an Arbitration Request
   2. Submit Supporting Documentation
   3. Arbitrator Selection and Case Review
   4. Hearing or Paper Review Process
   5. Decision

MRS Law Group incorporates the experience of health care attorneys, medical providers, and sophisticated IT systems to help expedite the arbitration process. We provide exceptional service to our clients at a competitive rate.

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