Report Shows Dispute Resolution Process in No Surprises Act Favors Providers

By Jack Hoadley and Kevin Lucia

The No Surprises Act (NSA) aimed to prevent surprise billing when patients unintentionally receive treatment from out-of-network providers or facilities. The law appears to be fulfilling that goal—consumers are mostly not receiving costly surprise bills. But the law also aimed to ensure a system of fair payments for insurers, health plans, facilities, and providers, establishing an independent dispute resolution (IDR) process of binding arbitration if providers deem a payment inadequate. On February 15, the Biden administration reported on IDR cases resolved in the first half of 2023, including offer amounts submitted by each party and the amount of the winning offer.

In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley and Kevin Lucia analyze the IDR data and what it means for patients, providers, payers, and health care costs. Although only 7 percent of out-of-network claims went through IDR, the February report shows significant growth in the number of IDR cases filed and resolved. Providers are winning a majority of cases, and these victories have come with substantial payouts. The authors also discuss the timeframe for these decisions, the role of private equity, and how these trends impact the cost containment goals of the NSA.

You can read the full blog post here.