Health transportation company Global Medical Response has around $4.3 billion of debt coming due in 2025, including $600 million of senior notes and $3.7 billion of a term loan. The firm signaled third-quarter growth and has kicked off talks about extending the debt, Bloomberg recently reported.

A spokesperson for Global Medical Response said the company supports the law, but that the majority of the firm’s disputed claims are still waiting in the arbitration process. The company is also experiencing delays in opening the resolution portal to submit new claims, according to the spokesperson. A representative for KKR, the firm’s private equity sponsor, declined to comment.

Medical practice network Radiology Partners, meanwhile, has a $440 million revolver due in November 2024, and more than $2 billion of debt maturing in 2025. S&P Global Ratings downgraded the company to CCC+ in June, citing cash outflows as a result of the law. A representative for the firm said the company has ample liquidity and that earnings haven’t been materially impacted by the No Surprises Act.

And at TeamHealth, the stakes are also high, even as it recently addressed a portion of its debt stack. The company still has $714 million of unsecured 2025 notes outstanding. If a majority of those notes aren’t refinanced, TeamHealth could face a springing maturity on all secured debt of more than $2.5 billion in November 2024.

A spokesperson for TeamHealth, said the company supports the No Surprises Act and added that the firm is using the dispute resolution process to get fair payment from insurers. A representative for Blackstone declined to comment.

While payers and providers are likely to eventually compromise on viable contracted rates for services and conclude ongoing litigation in the coming years, in the interim, there’s little certainty on how companies will fare.

“The question is what happens in between?” said Spencer Perlman, managing partner and director of health-care research at consultancy firm Veda Partners. “That also happens to be the period where a lot of these companies have to refinance — and that’s the big concern.”

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