Provider Wins In NSA Disputes Becoming Outlandish
More evidence that the terribly flawed No Surprises Act dispute process is getting more outlandish, yet lawmakers lack the courage to fix it. Meanwhile, awards continue to drive costs in the system in two ways – the sheer cost of the awards and driving up price points in the system overall.
A new federal analysis says disputes rose almost 75% to more than 2.5 million from 2024 to 2025. CMS originally projected just 17,000 cases a year when the law passed. Providers won 83.6% of disputes in Q4 2025, roughly consistent since 2023.
Provider groups of course claim the dollars awarded are merited. Health plans say providers are abusing the system and the process is incredibly slanted to providers. A long-delayed reform rule is likely destined to do little to change the paradigm.
It is also true that a small subset of certain specialists are raking in the highest awards. Surgical and neurology procedures have resulted in a huge increase in reimbursements. Insurers paid a median award equal to 2,585% of the qualifying payment amount for neurology procedures in Q4, up from 1,262% during Q4 2023.
Arbitration processes are meant to be a 50-50 proposition – not 84-16. And to show how biased the process really is, plans offering five times the qualifying payment amount still lose about 75% of the time.
#nsa #nosurprisesact #transparency #providers #healthplans
https://www.modernhealthcare.com/providers/mh-no-surprises-act-billing-disputes-idr
— Marc S. Ryan
