Two new lawsuits from Elevance Health subsidiaries are raising significant questions about how providers are using the No Surprises Act’s Independent Dispute Resolution (IDR) process. The cases, filed by Anthem Blue Cross and Blue Shield of Ohio and Blue Cross Blue Shield Healthcare Plan of Georgia, accuse healthcare providers and billing company HaloMD of submitting large volumes of ineligible claims through IDR to boost reimbursements and drive up arbitration costs.

What the Lawsuits Allege

In the Georgia complaint, Elevance asserts that 70% of the IDR cases were not eligible under the law but still led to nearly $390,000 in additional reimbursements and more than $118,000 in IDR fees. The Ohio case echoes those concerns, alleging more than $25 million in awards resulting from a strategy that Elevance calls “an abuse of the IDR process.” Both cases contend that these filings undermine the intent of the law and inflate costs for insurers, while sidestepping negotiated network agreements.

These filings reflect a broader industry pushback against the effectiveness of the No Surprises Act’s protections for out-of-network providers. While payers argue the process is being manipulated, these challenges may also represent an effort to limit provider access to fair reimbursement and shift financial control back to insurers, ultimately threatening the sustainability of out-of-network care models.

Why This Matters to Your Practice

Patriot Group believes that the IDR process, when used correctly, remains a vital tool for providers, especially those delivering emergency services or elective procedures at in-network facilities. By capping patient out-of-pocket costs and challenging low insurer payments, providers can secure appropriate reimbursements without burdening their patients.

Patriot Group’s legal and compliance team has the experience and knowledge to work with healthcare providers to navigate these complexities and submit strong, eligible IDR claims. We understand the nuances of the law and how to leverage it for optimal reimbursement results and long-term practice success.

If you are interested in increasing your organization’s revenue through the No Surprises Act and IDR, contact Thomas J. Force, Esq., President and Founder of Patriot Group, at [email protected] or call (631) 870-4040.