Surprise Billing process still Choked by Claims: Survey

According to updated estimates by health insurance associations, the restriction on unexpected medical costs shielded customers from over 10 million claims for out-of-network treatments in the first nine months of 2023. However, the procedure for resolving billing conflicts remains chaotic.

Why this matters: Between January 1, 2023, and September 30, 2023, over 670,000 claims were filed for arbitration, according to AHIP and the Blue Cross Blue Shield Association, and there is no indication that this number is approaching a high.

That surpasses federal projections of around 17,000 claims processed each year, and it begs the issue of whether these disagreements would ultimately have knock-on repercussions like increased premiums.

Quick refresher: Almost since the No Surprises Act went into force at the beginning of 2022, providers and insurers have been in conflict over numerous legal challenges to the Biden administration arbitration regulations.

Physicians have been complaining that the dispute resolution process is so slow that they have to wait months to get paid back and that insurers may occasionally disregard orders to pay or underpay providers.

Insurance companies argue that arbitrators have caused delays by grouping several rulings together, and that providers have contributed to delays in the system with pointless objections to billing rulings.

According to the insurance study, in 80% of disagreements, providers agreed to accept the insurers’ first payment offer.

An estimated 10.1 million qualified claims, or around 0.7% of all commercial claims, were handled by health insurers in the first three quarters of 2023.

Contrary to reports that the legislation is forcing doctors out of networks, two-thirds of insurers stated that their provider networks had expanded since it went into force.