Legal
Specialty Providers Challenge Georgetown Study on No Surprises Act IDR Costs
Specialty physician associations representing anesthesiologists, radiologists, and emergency physicians are disputing a Georgetown University study that estimates independent dispute resolution under the No Surprises Act has generated $22 billion in unnecessary healthcare spending. The associations argue the study's methodology is flawed. The No Surprises Act, which took effect in January 2022, established an IDR process for resolving payment disputes between out-of-network providers and insurers. While the law primarily affects commercial insurance, the dispute highlights ongoing tensions over payment methodologies that could inform Medicaid managed care network adequacy and payment dispute resolution policies.
Why it mattersPayment dispute resolution mechanisms and adequacy of network reimbursement rates remain central issues in Medicaid managed care, where states increasingly adopt similar arbitration processes for provider-plan payment disputes.