Do trauma call claims qualify for federal IDR?

Yes, always, when the surgeon is out-of-network. Emergency services from the ER through post-stabilization care are protected unconditionally; no consent form can waive them.

When does a notice-and-consent waiver block an orthopedic claim?

Only for scheduled, non-emergency surgery where the facility delivered proper notice at least 72 hours ahead with a good faith estimate, an in-network alternative existed, and the patient validly signed. Missing any element voids the waiver, and payers often cannot produce the executed form.

Are assistant surgeon claims eligible?

Yes, unconditionally. Assistant surgeons are on the No Surprises Act's never-waivable list, so an out-of-network assist at an in-network facility is protected even when the primary surgeon's claim was validly waived.

Answers / Can orthopedic surgeons use IDR

Can orthopedic surgeons use federal IDR?

Yes. Out-of-network emergency and trauma care always qualifies for federal IDR, and scheduled surgery at in-network hospitals or ambulatory surgery centers qualifies unless the patient signed a valid notice-and-consent waiver for the operating surgeon. Waivers are never valid for emergencies, for cases with no in-network alternative, or for assistant surgeons.

Trauma call is always protected

Emergency services cannot be waived, period. The hip fracture that comes in overnight, the open fracture washout, the compartment syndrome release: when the surgeon is out-of-network, those claims are protected from the emergency department through post-stabilization care, and the payer's payment is arbitrable in federal IDR. For groups taking uncompensated or under-compensated trauma call, this is the forum where the facility-based portion of that work gets priced, and the 2025 record shows it pricing well.

Scheduled cases and the waiver

Scheduled surgery is where orthopedics differs from the ancillary specialties. Because a patient can in principle select their surgeon ahead of time, the law allows a facility to present a notice-and-consent form at least 72 hours before a scheduled procedure that, if validly executed, waives protection for the operating surgeon's claim. The conditions are strict: proper timing, a good faith cost estimate, and a genuine in-network alternative available at the facility. Forms that miss any element do not count. A group auditing its scheduled out-of-network cases should ask for the executed waiver before conceding any claim; payers assert consent far more often than they can produce it.

Assistant surgeons cannot be waived

The statute lists providers for whom consent is never valid, and assistant surgeons are named on it. In practice this means the first assist on an out-of-network basis at an in-network facility holds a protected claim regardless of any paperwork, including cases where the primary surgeon validly waived. For orthopedic groups that staff assists across partners, or use surgical assistants, this is a quietly reliable stream of eligible claims.

The boundaries

Office procedures do not qualify, because an office is not a facility under the statute; the facility list is hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgery centers. Medicare, Medicare Advantage, Medicaid, TRICARE, and workers compensation claims are outside the federal process entirely. Self-pay surgical patients are covered by good faith estimate rules instead. State arbitration regimes can apply to state-regulated plans, while self-funded employer coverage routes federal.

Sort your case list by the rules

Lido IDR screens orthopedic cases for eligibility, challenges unsupported consent assertions, and files what qualifies for a flat fee per arbitration. Talk to an IDR specialist.