The Errors Of The No Surprises Act
A great Health Affairs Forefront blog on the huge admin and steep payment costs in the No Surprises Act dispute resolution process. While Americans are being sheltered from surprise bills, the process is a mess and appears to be driving up overall costs in the healthcare system. Further, the process is being abused by a small sunset of greedy private equity-baced provider organizations.
A few findings from the blog:
- Providers have brought far more disputes than anticipated.
- They won 85% of the decisions in 2024.
- Providers receive fees that are three to four times the typical in-network rate.
- The high-volume of disputes is generating significant admin costs as well as higher payments. This will be recognized in overall healthcare costs and premiums.
- At least $5 billion in total costs have accrued through the end of 2024.
- In 2023 and 2024, 43% of resolved line-item claims were filed by two private equity-backed provider organizations: Radiology Partners and affiliates and Team Health. The top five provider organizations were responsible for 59% of line-item claims.
This is a tragedy and Congress needs to get a backbone and amend this provider-slanted law.
(Article may require a subscription.)
#nsa #nosurprisesact #transparency #providers #healthplans #surprisebilling
Humana In Enviable Position Compared With United
Interesting article in Modern Healthcare comparing the relatively enviable position of Humana, with surging stock prices, right now vs. the current meltdown suffered by UnitedHealth Group. Of course, a great deal is attributable to the fact that Humana recognized huge issues in Medicare Advantage (MA) some time ago and realigned benefits and products and contracted geographies for 2025. While United did some of that in 2025, it has just recognized the need to shed as many as 600,000 lives in 2026.
It is safe to say, though, that all health plans will continue to see financial volatility due to the passage of the budget reconciliation act as well as rising utilization.
#medicareadvantage #unitedhealthcare #humana #healthplans #margins
https://www.modernhealthcare.com/insurance/mh-humana-unitedhealth-medicare-advantage-strategies/
— Marc S. Ryan
