Ohio: HB 388 arbitration and federal IDR for out-of-network providers

Ohio uses a payment standard plus arbitration

Ohio's surprise-billing law (HB 388), effective January 1, 2022, protects patients from balance bills for unanticipated out-of-network care and sets an initial payment standard: broadly, the greatest of the plan's median in-network rate, the usual and customary amount, or the Medicare rate. If the provider isn't satisfied, the law allows the parties to take individual or bundled claims to arbitration above a dollar threshold.

Why the two tracks pay differently

• Under a payment standard, your upside is capped by the formula.
• Under federal IDR, a well-documented offer can land well above the qualifying payment amount — providers have prevailed in roughly 88% of federal determinations, and awards frequently exceed comparable in-network rates by several times.
• Which is why routing matters: the same CPT code can be worth very different amounts depending on the plan behind it.

What we do for Ohio groups

• Screen remits by plan type and route each claim correctly
• File open negotiation, then initiate within the federal four-business-day window
• Bundle state claims where the threshold requires it, batch federal claims by payer and code
• Chase payment after determination

Thresholds and payment standards change. We verify current rules before filing.