Jan 30, 2024 - Health

Surprise billing process still choked by claims: survey

Illustration of a crumpled paper bill atop confetti

Illustration: Natalie Peeples/Axios

The ban on surprise medical bills protected patients from more than 10 million claims for out-of-network services in the first nine months of 2023, according to new estimates by health insurer groups. But the process for settling billing disputes is still in disarray.

Why it matters: AHIP and the Blue Cross Blue Shield Association said more than 670,000 claims were submitted to arbitration between Jan. 1 and Sept. 30, 2023, with no sign that the number is peaking.

  • That eclipses federal estimates that about 17,000 claims would go through the process annually and raises questions about whether the disputes will eventually have trickle-down effects like higher premiums.

Catch up quick: Multiple legal challenges to the Biden administration arbitration rules have kept providers and insurers at odds almost since the No Surprises Act took effect at the beginning of 2022.

  • Doctors have complained that insurers sometimes ignore rulings to pay providers or fail to pay them in full — and that the dispute resolution system is so bogged down they have to wait months to get reimbursed.
  • Insurers contend that providers are clogging the process with frivolous challenges to billing decisions and that arbitrators have contributed to delays by bundling multiple decisions together.

The insurer survey found that providers accepted the insurers' initial payment offer in 80% of disputes.

  • During the first three quarters of 2023, there were an estimated 10.1 million eligible claims, or about 0.7% of all commercial claims, processed by health insurers.
  • Two-thirds of insurers said their provider networks grew since the law took effect, countering claims that it's prompting doctors to leave networks.
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