SOURCE: BillingNav – Health Plan Guardians
The No Surprises Act was supposed to protect patients from balance bills. And it does. But here’s the flip side: employers and plan sponsors are the ones footing the bill — and it’s getting expensive.
Aetna’s lawsuit against Radiology Partners highlights what many of us in the industry are seeing:
* IDR awards are coming in at 3–4x Medicare rates.
* Providers backed by private equity are winning close to 90% of the time.
* That means there is little incentive to negotiate contracts when the IDR “ATM” pays better.
Yes, patients are spared the surprise bills. But the costs haven’t disappeared. They’ve just moved upstream, and if you are a self-funded employer, you are the one holding the bag.
This is why we spend so much time helping clients navigate the NSA, defend against balance bills, and design smarter benefit strategies. Because without it, plans risk overpaying, and not even knowing it.
Do you think IDR is fixing the problem, or just moving it around?
