When Congress passed the No Surprises Act, the goal was clear: protect patients from unexpected out-of-network medical bills. The law has largely succeeded in that regard, shielding patients from most surprise bills — especially large balance bills tied to emergency care and procedures at in-network hospitals. But a recent report from Third Way highlights how certain private equity-backed providers and new “IDR middlemen” are abusing arbitration to pursue higher payments and drive-up costs for patients, employers, and health plans.
Third Way’s report underscores how the process that was supposed to be a “last resort” has become the go-to business strategy for private equity’s profit push.
Among the key takeaways:
- “The creation of a flawed arbitration process allows certain providers to continue exploiting the system and inflating patients’ costs.”
- “If left unaddressed, the arbitration system risks becoming a permanent cost escalator — one that benefits high-charging providers at the expense of patients and payers alike.”
- “Patients became collateral damage in a business model designed by providers to exploit gaps in insurance networks and to force payers into paying inflated charges.”
These higher awards don’t disappear; they often translate into higher premiums and rising costs across the health care system. As arbitration outcomes skew higher and higher, those increased costs are inevitably passed to employers and consumers, undermining the affordability goals the law aimed to achieve.
Without reform, the promise of the No Surprises Act risks being undermined, and patients could once again find themselves paying the price. To address these challenges, the Coalition Against Surprise Medical Billing (CASMB) is urging the Trump administration to implement common sense reforms to protect consumers from inflated arbitration outcomes and price gouging.
Read the full article online here. For more information on the No Surprises Act, visit: www.stopsurprisebillingnow.com
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