Mar 22, 2026

Hello friends,

I recently heard some important updates about the ongoing efforts to manage surprise medical billing in the U.S. The No Surprises Act, passed over five years ago, aimed to protect patients from unexpected charges when receiving care from out-of-network providers. While this law has made great strides in shielding patients from surprise bills, the negotiation between insurers and healthcare providers over payments is still very active and evolving.

Interestingly, it turns out that healthcare providers have been quite successful in arbitration cases meant to settle payment disputes with insurers. Since April 2022, millions of these disputes have been filed, and providers have won about 88% of the cases where payments were determined. Even more surprising is that the payment amounts awarded often exceed the initial benchmark rates, which were designed to reflect typical in-network prices. This shows that some provider groups have found ways to negotiate higher payments, pushing the system beyond its original expectations.

However, winning these disputes doesn’t always guarantee quick or easy payment. There have been reports of insurers delaying or even withholding payments after arbitration rulings favor providers. This has caused some frustration among physicians and provider groups, indicating that while the arbitration process is a fair way to resolve conflicts, it still faces challenges in enforcement and timeliness.

The disputes are largely concentrated among a few major players. Just a handful of insurers—like UnitedHealthcare, Blue Cross Blue Shield of Texas, and Aetna—are involved in most arbitration cases. On the provider side, groups such as HaloMD, TeamHealth, Radiology Partners, and SCP Health are the main initiators of these disputes and tend to secure substantial payment awards. This concentration has led to some high-profile court cases as both sides work to clarify their responsibilities and rights.

Despite these ongoing negotiations and challenges, the overall picture remains positive. The No Surprises Act has successfully protected patients from unexpected bills, which is a huge win for healthcare consumers. Now, the focus is on refining the arbitration process to ensure timely and fair payments between insurers and providers while keeping healthcare costs in check.

It’s encouraging to see continued efforts to improve this system and reduce administrative burdens, so that healthcare providers and insurers can collaborate more smoothly. With ongoing attention and thoughtful reforms, I’m optimistic we’ll achieve a more efficient and equitable resolution process that benefits everyone—most importantly, the patients.

Stay well and informed!

Summy

Stay Well!