Health care providers are winning the vast majority of payment disputes resolved under the No Surprises Act’s Independent Dispute Resolution process.
Contrary to the expectation that the number of cases the process would adjudicate would decline once payers and providers got a better sense of what kinds of cases were being disputed and their outcome, the number of cases going into the process has only grown – considerably.
And so has providers’ success rates. Providers won 70 percent of the disputes during the first quarter of 2023 and that rate rose to 87 percent by the fourth quarter of that year – and then stayed at that level during the first two quarters of 2024. Most cases involve disputed ER and radiology claims and cases are concentrated in a number of states: Texas, Florida, Arizona, Tennessee, Georgia, New Jersey, and New York, with the provider success rate exceeding 90 percent in some of those places. Four payers – United Healthcare, Aetna, HCSC, and Anthem – have been involved in two-thirds of the disputes.
Equity-backed provider groups are proving especially successful in disputing payers’ proposed payments.
Learn more about how dispute resolution is faring under the No Surprises Act from the Health Affairs article “Independent Dispute Resolution Process 2024 Data: High Volume, More Provider Wins.”