The fate of the No Surprises Act's independent dispute resolution (IDR) clause continues to hang in the balance as it winds its way through the courts.
The No Surprises Act, signed into law in 2020 by President Donald Trump, was intended to protect patients from unexpected bills for care from out-of-network providers and to ensure fair contracts between health plans and physicians. It requires health plans and providers to resolve their billing disputes by establishing an IDR arbitration process in which the insurer and the provider each come up with an offer and an independent third party chooses one of the two.
Last month, U.S. District Judge Thomas Thrash Jr., in Atlanta, dismissed a lawsuit by a Georgia subsidiary of health insurer Elevance against HaloMD, a medical billing company, and two physician groups. The insurer alleged that HaloMD and the physicians had defrauded Elevance by initiating thousands of out-of-network billing disputes in the second 6 months of 2024, garnering close to $6 million in awards that Elevance alleged were improper.
The judge didn't rule on the merits of the case itself, but instead said that the court lacks jurisdiction to re-litigate the awards, especially since the law deliberately protects them from further legal review. Elevance plans to appeal the decision, according to a report in Becker's Payer Issues.
