No Surprises Act Dispute Process Favors Providers
The No Surprises Act (NDA) remains a huge mess with volume 13 times higher than forecast for 2023. What’s more, providers won 77% of arbitration cases and health insurers won in 23% of cases. The winning offers were above the qualifying payment amount, which is the median in-network rate.
The good news is that 10 million surprise bills were avoided with the law in the first nine months of 2023. The bad news is that providers are winning huge in the baseball-style arbitration as they do in other states that have it. Studies show that rates and premiums rose in those states under the provider-friendly process. Researchers say that will happen nationwide now. Yet, providers continue to sue to get things even more slanted toward them. Congress has to even the playing field. But they won’t as lawmakers from both sides of the aisle are provider-friendly due to campaign contributions and hospital board seats.
Evidence too that a small number of firms are driving cases. And the three largest are all private equity or venture backed.
Additional article here: https://www.fiercehealthcare.com/regulatory/surprise-billing-disputes-continue-far-outpace-federal-estimates-cms
#privetequityfirms #providers #nsa #nosurprisesact #surprisebilling