No Surprises Act Update: Regulatory and Litigation Developments, Ongoing Compliance Challenges for Stakeholders

Mr. Arters leverages a deep understanding of the issues health care entities encounter in the constantly evolving health care industry to serve providers’ business and legal objectives. He has experience representing a diverse group of health care entities, including premier-profit and not-for-profit hospital systems, hospital associations, ambulatory surgery centers, air ambulance service providers, specialty providers, national physician groups, ancillary service providers, and medical device companies. Mr. Arters’ practice focuses on managed care disputes, strategies, and litigation, which is supported by over a decade of experience assisting clients to ascertain tailored solutions to complex commercial disputes through strategic negotiation, mediation, arbitration, and litigation in state and federal courts across the U.S. He counsels clients on a broad range of commercial and managed care matters, including federal No Surprises Act compliance and operations, Administrative Procedure Act challenges, underpayments and denials, recoupments and offsets, commercial payor audits, network contracting, out-of-network reimbursement, and code-editing and down-coding policies, among other matters.

Ms. Boaz brings her analytical skills and client-focused approach to represent and advise a diverse group of health care clients, including health plans, clinical laboratories, pharmaceutical companies, pharmacy chains, telehealth providers, medical device companies, hospitals and health systems, management services organizations, and other clients. She focuses her work on regulatory due diligence, regulatory counseling, and policy and legislative analysis. Ms. Boaz walks clients through: plan and issuer-side compliance with the No Surprises Act, the Transparency in Coverage rules, and other requirements under the Consolidated Appropriations Act; provider and facility-side compliance with the No Surprises Act and state surprise and balance billing laws, particularly on matters impacting providers, facilities, and clinical laboratories; and provider and facility compliance and implementation with “Good Faith Estimate” requirements, including with the preparation of customized forms, among other matters. She also closely follows developments to keep clients up to date on surprise billing and prescription drug pricing matters, the individual marketplace, and developments in Medicare.

Mr. Mazzola focuses his practice in the areas of ERISA and managed care litigation; life, health, and disability benefit litigation; and related insurance coverage issues. He has spent much of his career litigating complicated life, health, and disability insurance related claims and disputes. Mr. Mazzola defends life, health, disability and accidental death and dismemberment claims brought in state and federal court against insurers, plan administrators, employers, benefit plans, managed care organizations, PPOs, HMOs, third party administrators, and pharmacy benefit manager, including in cases governed by ERISA, Federal Employees Health Benefits Act (FEHBA), and the Federal Employees' Group Life Insurance program. He has experience in many areas of life, health, and disability litigation, including complex health care issues involving ERISA, FEHBA and Medicare preemption, payor/provider contract disputes, nonparticipating provider reimbursement claims involving both federal and state law claims, pharmacy benefit plan/provider disputes, and behavioral health claim disputes, including claims alleging violations of federal and state Mental Health Parity and Addiction Equity laws. Mr. Mazzola manages litigation from inception through trial/arbitration, tirelessly working to obtain the most beneficial resolution for his clients. He also has written many appellate briefs for clients in the United States Court of Appeals for the Second Circuit and the New York State Appellate Divisions involving complicated legal issues in both ERISA and non-ERISA cases.