"When we have an in-network surgeon who has agreed to $800 for the reimbursement for that surgery, but an assistant surgeon takes that same case to IDR, and they get $80,000, that is unsustainable. ... This is crazy - we have got to fix this problem."
"Recently published data from another panelist backs this up. Kennah Watts explained that there have been 3.4 million IDR disputes from 2022 through June 2025, while CMS anticipated about 55,000 over that same time period."
"Watts added that providers and healthcare facilities are initiating 99% of disputes."
The No Surprises Act was designed to protect patients from unexpected medical bills and facilitate negotiations between insurers and providers. However, Katy Spangler highlighted issues with the Independent Dispute Resolution (IDR) process, which is being exploited by providers. The volume of IDR cases has surged, with providers winning most disputes at inflated amounts. Recent data indicates that providers initiate 99% of disputes, far exceeding initial projections by CMS, raising concerns about the sustainability of the system.
#no-surprises-act #independent-dispute-resolution #healthcare-policy #medical-billing #patient-protection
Read at MedCity News
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