From an article about RANT’s fight with BCBS in Radiology Business:
Under the No Surprises Act, enacted by Congress in 2020, physicians and payers can settle disputes over out-of-network healthcare services. This is meant to protect patients from unexpected bills, which proponents say the NSA is achieving. Radiologists and other docs are reportedly winning in the “independent dispute resolution,” or IDR, process at a high clip. The law allows these outside arbitrators to issue binding decisions for imaging and other services, but health insurers are now refusing to pay up afterward.
Radiology Associates estimates it has prevailed in about 95% of finalized IDR disputes with Blue Cross Blue Shield of Texas, the state’s largest insurer. However, more than $3.5 million in awarded balances remain unpaid. RANT estimated that $1.64 million of this total has been outstanding for over 120 days. As of Tuesday, BCBS Texas has paid approximately 2% of awarded balances.
RANT also expressed concern about restrictions around how radiology practices can batch together claims to be submitted to the IDR process. Current rules force the practice to divide similar claims into thousands of smaller arbitration filings, each carrying separate filing and IDR fees. Under current federal interpretation of the law advocated for by BCBS of Texas, Radiology Associates says it will file over 68,000 payment batches, with total administrative cost of nearly $53 million. Under an ideal process, RANT estimated it would have submitted 1,369 batches for a total administrative tally of $1.05 million.
Say what you want about the NSA, but it’s the law of the land. Losing in binding arbitration and then not paying the awards is bullshit. If an insurance company doesn’t like the awards when they lose, they can negotiate in good faith and get the physicians back in-network.
The idea that the batching of essentially identical claims should be reduced to tiny numbers will only make the process more cumbersome, less efficient, and more expensive. It’s a terrible interpretation of the law.