Assure Holdings was a U.S. provider of outsourced Intraoperative Neurophysiological Monitoring (IONM) services — real-time nervous system monitoring during invasive surgeries to alert surgeons to potential nerve damage before it becomes permanent. Assure delivered two components: a Technical Component, where on-site neurophysiologists monitored neural activity in the operating room on a one-to-one basis, and a Professional Component, where off-site supervising practitioners provided remote neurology oversight via telehealth across multiple simultaneous cases. Assure billed commercial insurers directly as an out-of-network provider, meaning reimbursement rates were not contractually fixed and were subject to negotiation and arbitration. The gap between gross billed and net collected revenue was large and unpredictable. Assure built an in-house revenue cycle management function to navigate complex billing and arbitration processes, which it viewed as a key competitive advantage in a fragmented market. The business faced severe reimbursement pressure — average reimbursement per procedure fell roughly 67% between late 2020 and mid-2023 — which ultimately forced a strategic pivot. In early 2024, Assure sold most of its clinical operations to National Neuromonitoring Services for $2.32M in cash plus a potential earnout, and entered into a merger agreement with Danam Health, a pharmacy-focused healthcare solutions company. Assure's remaining legacy IONM operations are limited to Arizona and Montana.