“Modern Healthcare recently reported that HaloMD is the leading claims initiator in No Surprises Act’s Independent Dispute Resolution system, which fielded 6.3 million out-of-network billing cases from its inception in 2022 through last month, far surpassing expectations. In the second quarter of last year, for instance, HaloMD was involved in 22% of IDR cases, according to a study the Georgetown University Center on Health Insurance Reform released in March.
That’s made HaloMD a villain to health insurance companies and health plan sponsors, which charge that it games the IDR system at their expense. It’s also demonstrated that focusing on No Surprises Act claims can be a lucrative business.
HaloMD contracts with providers and leads them through the arbitration process. HaloMD operates on a contingency basis and earns a percentage of the net payments awarded to providers. The company represents more than 20,000 providers in a range of specialties, Velliky said.
More than three-quarters of its clients employ fewer than 100 clinicians and nearly one-quarter have fewer than five, he said.
The company boasts an IDR success rate exceeding 90% and worth more than $1 billion in reimbursements, according to a video the company posted on YouTube in April 2025.”
Sunday Morning Bathroom Read Takeaway:
The number one reason to be bullish on HaloMD:
1)”Turbocharging rates relative to costs” is expressly illegal in the Medicare market (tax dollars at risk);
2)”Turbocharging rates relative to costs” in the commercial market is sanctioned by the government for providers eligible under the the NSA;
3)Let that sink in for a moment: The NSA provider QPA is increasing at geometric levels since the implementation of the NSA. Just look at pre-NSA chargemaster rates vs. today’s chargemaster rates. More to the point, even if the provider “loses” in the IDR process, the provider is still winning because the year-to-year increase in rates offsets any loss.
Bottom Line:
The HaloMD business model, which is based upon a percentage of the “net payment awarded to providers”, is no different than the Multiplan business model which is typically based upon a “cost of savings”: HaloMD wins 90% of the time and the other 10% where they “lose” it really does not matter because chances are the “loss” still netted their client a win because the QPA was already inflated.
Happy Father’s Day. First day of school at Holy Cross School, Champaign, IL 2002.
