10 payers that are involved in the most No Surprises Act disputes

Ten payers are involved in 85 percent of all disputes involving out-of-network emergency and nonemergency items in services under the No Surprises Act's independent dispute resolution process, according to a recent CMS report

The 10 companies that have initiated the most disputes can be viewed here.

Top 10 non-initiating payers or groups for disputes initiated from April 15 to Sept. 30, 2022:

  • UnitedHealthcare: 24 percent
  • Aetna: 14 percent
  • MultiPlan: 11 percent
  • Elevance Health (Anthem): 10 percent
  • Cigna: 9 percent
  • BCBS Texas: 5 percent
  • Clear Health Strategies: 4 percent
  • Florida Blue: 4 percent
  • BCBS Illinois: 2 percent
  • BCBS Tennessee: 2 percent

HHS launched the independent dispute resolution portal in April and said it received more than 90,000 claims in the first five and a half months. A CMS spokesperson told Bloomberg Law in November that the figure is "substantially more than the department initially estimated would be submitted for a full year." 

Because the process is new, there is uncertainty about whether it favors insurers, providers or somewhere in between. 

The Texas Medical Association filed its first lawsuit against the No Surprises Act in October 2021, successfully arguing that requiring arbitrators to heavily weigh figures created by insurers conflicted with the law and provided insurers with an unfair advantage unintended by Congress. 

A second lawsuit from the TMA was filed against the process Sept. 22 in a Texas federal court alongside UT Health Tyler Regional Hospital and a physician. On Oct. 19, the American Hospital Association and the American Medical Association, along with 30 additional national and state medical groups, filed amicus briefs in support of the lawsuit. On Dec. 20, the court began hearing arguments from the involved parties.

The TMA filed a third federal lawsuit challenging the Act in November, arguing that portions of the rule "artificially deflate the qualifying payment amount."

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