A recent letter from the ERISA Industry Committee (ERIC) urges the IRS to revise the No Surprises Act’s (NSA) dispute resolution framework, claiming it places too much financial pressure on employer-sponsored health plans. According to ERIC, out-of-network providers are winning the majority of arbitration cases and receiving payments significantly higher than in-network rates.

But this position misses the point of the NSA. The law was never designed to let insurers dictate reimbursement with no meaningful checks. Rather, it was created to protect patients from surprise medical bills while offering providers a neutral, independent process to dispute low payments from payers.

ERIC’s latest comments essentially suggest providers should be barred from billing patients and forced to accept whatever an insurer offers, no questions asked. This interpretation undermines both the intent of the NSA and the rights of providers. It’s not about inflating costs; it’s about fair reimbursement for medically necessary services.

For out-of-network providers, now is the time to take full advantage of the Independent Dispute Resolution (IDR) process before mounting regulatory pressure leads to restrictive changes. Providers delivering emergency services or non-emergency procedures at in-network facilities can pursue higher payments through IDR, while keeping patients protected with capped, in-network cost-sharing.

At The Patriot Group, our attorneys have extensive experience representing clients in IDR. We’ve achieved a strong success rate by building detailed, compelling submissions that result in significantly improved reimbursements for our clients. This process allows providers to remain out-of-network while still being paid fairly, without sacrificing patient satisfaction or facing balance billing disputes.

The bottom line: IDR has become a powerful and often lucrative tool for providers. The window to act may narrow as regulatory revisions are considered, so the time to explore your options is now!

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.