“Insurers will know that they can lowball their initial payment and then ignore a subsequent IDR award ordering them to pay more — and there will be nothing providers can do about it.”
By Doug Aldeen – ERISA Healthcare Attorney and Fractional General Counsel – Visit my website
The US Supreme Court this week raised new questions about enforcement of the No Surprises Act’s independent dispute resolution (IDR) process. The high court denied a petition by two air ambulance companies to review a circuit court’s 2025 decision that IDR awards are not enforceable in federal court. That opinion by the U.S. Court of Appeals for the Fifth Circuit removes litigation as a tool for ensuring health plans pay IDR awards. The plaintiffs say the Fifth Circuit’s ruling essentially allows insurers to avoid making required payments, a situation that could contravene Congress’s intent in drafting the No Surprises Act (NSA).
“If the Fifth Circuit decision stands, Congress’s scheme will be upended,” the plaintiffs wrote in their petition to the Supreme Court. “Insurers will know that they can lowball their initial payment and then ignore a subsequent IDR award ordering them to pay more — and there will be nothing providers can do about it.”
Sunday Morning Bathroom Read Takeaway:
“If the government managed the Sahara Desert, it would run out of sand in five years” ( Milton Friedman)
Consider:
1.By implementing the current framework of the NSA/IDR process coupled with the success of providers (84% “win” rate), Congress ( legislative branch) essentially sanctioned employer balance billing at rates that far exceed what anybody would pay in a free and transparent market;
2.To add insult to injury, now that the US Supreme Court ( judicial branch) has denied a writ of certiorari to review the matter, the government has essentially imposed a “de facto” contract on providers at the QPA level. What the government giveth, the government taketh away;
3.At this stage of the game, now only the fourth branch of government ( lawyers) can fix the problem… .
That is government owned, controlled, and operated health care.
