National nonprofit organization working to ensure fair outcomes for critical #healthcare issues. Our special projects @anthem_watch, @statecarenet.
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In a new op-ed for @CrainsNewYork today, our President Christopher Sheeron explains how health insurance plans are driving healthcare costs.
He also argues that Albany’s removal of Medicaid Managed Care disputes from the state's IDR process deserves scrutiny. Undoing this budget failure will keep patients—rather than health insurers’ financial incentives—at the center of Albany’s healthcare policy.
crainsnewyork.com/opinion/co…
Action for Health retweeted
At STAT Summit, Auchincloss said Dems should make insurers the villain in the health care system, not biotech.
Action for Health retweeted
Insurers caused 9 of every 10 defaults in federal arbitration in 2025. They offered $1 or less 278,807 times. Half the time, they offered their own artificially low number or less.
Now Representative Pallone's bill would let them skip the arbitrator altogether.
Keep the referee.
Read more here: indemed.org/keep-the-referee
@IndeMedAction
Action for Health retweeted
Does the Brookings Institution Board of Trustees meet every month to find a way to lower its income? Calls its donors to see if they can donate less next year than the year before?
Why should healthcare cost less every year when the healthcare customers’ employers not seeking the same goal? My bank, my IT/cloud provider, Telecom provider, insurance provider are not lowering their rates every year.
Action for Health retweeted
Rep. Pallone (D-NJ) has issued his new bill to reform the #NoSurprisesAct and let me count my top 3-4 reasons why it is a trainwreck for physicians and hospitals (and wait until you see #4):
1. IDR would be eliminated in favor federal rate setting at the "qualifying payment amount" (QPA or initial payment determined by the health plan).
There is no recognition here that the federal district and appellate courts (TMA I, II, III and IV plus 2 appellate court decisions, so 6-0 for the TMA) have found issues with the administration of the QPA and recently that the QPA rules should be void and have no legal effect due to health plans' inclusion of ghost rates and other QPA manipulations (TMA III US Court of Appeals for the Fifth Circuit, Aug. '26).
The Rep. includes the CPI-U adjustment in his bill which is laughable as the current law requires it and few if any plans actually comply with the requirement. One reason--no real audits of the QPA (see #4 below).
Why? The current CPI-U is +28% from a 2019 baseline.
2. No other factors would be considered in final payment--just blatant federal rate setting.
NSA requires acuity of the Pt, prior contract rates, qualifications of the clinicians and one can use the Transparency in Coverage (TiC) data which shows market rates among other factors for the IDRE to consider--none of that for Mr. Pallone.
Ask your colleagues in CA and MI how they like state based rate setting for applicable OON claims?
3. Another laughable provision--payment w/in 30 days but no interest or penalties--and yes that is in the current NSA.
As I have cited so many times here, the data is overwhelming that the plans are in systemic non-compliance with payment. Why would they comply in the future without enforcement, penalties or interest?
4. My favorite--no judicial review of the QPA. The plans have the ultimate and unquestionable power to set the QPA and never be questioned by any physician or hospital in court.
Oh, CMS can audit and that's true today. 4+ years ago CMS announced they were conducting over 20 audits, one has been announced in that time and the plan was out of compliance with setting the QPA.
To the physician and supporting community--time to get ready to become active again to preserve and enhance the NSA.
If that bill above becomes law, independent practice as we know will largely cease for groups actually accepting insurance and patient access to care will greatly suffer.
democrats-energycommerce.hou…
Action for Health retweeted
No Surprises Act: Another federal court rejects an insurer’s attempt to relitigate IDR eligibility. @AnthemBCBS v. AGS Health was dismissed WITH PREJUDICE. The court held NSA judicial review limits cover eligibility not just the payment amount.
@DOGE @RobertKennedyJr @DrOz @realDonaldTrump
@RepRaulRuizMD @DrKimSchrier @RepHerbConaway @herbconaway @MaxineDexterMD @Morrison4MN @RepBera @RepMMM @RepMarkGreen @RepGregMurphy @RepRonnyJackson @RepJohnJoyce @RepNealDunn @RepAndyHarrisMD @RichforGA @RepDesJarlais @SenJohnBarrasso @SenBillCassidy @RogerMarshallMD @DrRandPaul @MikeKennedyUT @BobOnderMO
@RepRaulRuizMD @DrKimSchrier
@RepHerbConaway
@MaxineDexterMD @Morrison4MN
@RepBera
@GOPDoctors
litigationtracker.law.george…
Our President Christopher Sheeron was honored last week to moderate a panel on choosing the right AI partner in a new clinical era at @physicianhosp's annual Leadership Summit in Napa Valley.
Action for Health retweeted
It's back to school season. Millions of students are cracking open new textbooks this month — so it's a good time for the rest of us to sharpen our pencils too.
✅Today's class: IDR 101.
1. When an out-of-network physician and a health plan can't agree on payment, who settles it? Meet the independent arbitrator, and learn how the No Surprises Act's Independent Dispute Resolution process actually works.
2. Here's the first thing to know: most payment disputes between providers and insurers are settled in the informal process, before an arbitrator is ever involved. And there's a reason the system is built that way.
3. Federal IDR is winner-take-all. Once a dispute reaches arbitration, the certified entity must pick one side's final offer or the other — it cannot land on a blended figure and it cannot split the difference. That design is deliberate. The No Surprises Act forces both sides to carry real risk into arbitration, which is meant to push them toward agreement earlier, during the mandatory 30-business-day Open Negotiation Period that comes first.
4. The takeaway is simple: your leverage is highest before arbitration begins. A reasonable number agreed during Open Negotiation is certain. A number left to an arbitrator is not.
Learn more about the IDR from IndeMed:
indemed.org/IDR-101/
Action for Health retweeted
Disruption no longer unfolds over years. It happens in months and even weeks.
These five physician-led healthcare leaders are at the front of all of it.
Grateful to have them with us at PHA's 2026 Leadership Summit these next few days to explore where healthcare is headed.
Action for Health retweeted
The Greedy Health Insurers are full force to protect profits by misleading employers, government officials and even think tanks. It’s simple. Pay providers a reasonable rate for caring for patients and stop the Obstruct, Deny and Delay to protect profits. axios.com/2026/09/17/surpris…
Action for Health retweeted
The House is planning to return next week. HR 4710 (the bill referenced below) could be on the docket for "mark up" by the Ways and Means health sub-committee.
Congress Is Returning. Act Now on the No Surprises Act Enforcement Act. votervoice.net/Shares/BpzzuA…
Action for Health retweeted
The number of bids at or below $1 aren’t just alarming. They are accelerating. In early 2023, $1 or less bids were 2.5% of all claims. By 2025 Q2 that number was 12.5%.
Why are insurers bidding less every quarter? Why don’t they value the services physicians render?
Read more detail here:
indemed.org/whats-your-care-…
What is saving your life worth?
278,807 times, the insurer offered $1 or $0 for the life-saving care delivered by physicians.
‼️ Insurers will say these were claims they believed didn’t belong in arbitration in the first place. That’s not what the data shows. Every one of these offers came after a certified, neutral federal arbitrator had already reviewed the claim and confirmed it qualified for the process. The eligibility question was already settled. The $0 or $1 offer came after.
Learn more:
indemed.org/whats-your-care-…
While getting IDR eligibility right is important, @EnergyCommerce's time, energy, and resources would be much better spent looking into how and why health plans continue not to pay for the legally binding decisions these IDREs make.
democrats-energycommerce.hou…
Action for Health retweeted
What is your care worth?
26 times, an insurer offered nothing for a newborn baby's first day fighting for its life in intensive care.
‼️ Insurers will say these were claims they believed didn’t belong in arbitration in the first place. That’s not what the data shows. Every one of these offers came after a certified, neutral federal arbitrator had already reviewed the claim and confirmed it qualified for the process. The eligibility question was already settled. The $0 offer came after.
Learn more from IndeMed:
indemed.org/whats-your-care-…
Action for Health retweeted
1/To counter the proverbial tidal wave of misinformation from the health plans on #NoSurprisesAct, @RadiologyACR @StrategicRad @ZotecPartners and Radiology Associates of North Texas (RANT) met w/ CMS to show officials how the largest independent radiology group in the US was forced out of network by @BCBSTX.
TX Blue refused to pay market rates to RANT after not paying an inflationary adjustment for years. Speaking of years, RANT spent over 1 yr negotiating w/ BCBSTX, over 25 documented attempts.
How did RANT know what “market rates” were? Easy—in network and out of network rates by TIN, CPT and geozip are mandated to be disclosed by health plans in the Transparency in Coverage (TiC) regulations.
Most plans reject that TiC data out of hand despite that it is their data.
Finally, again, RANT’s example is Exhibit A for why HR 4710 must be enacted to penalize plans who do not pay per the NSA law.
Make no mistake—the plans are ready to convert HR 4710 into their own “benchmarking bill” (that’s what we defeated in ‘18-‘19) w/ an IDR process you wouldn’t wish on anyone, just like Michigan’s state law. OON payments benchmarked to 150% of CMS w/ an entirely dysfunctional IDR process, in MI.
Radiology groups meet with CMS chief of staff to discuss No Surprises Act concerns radiologybusiness.com/topics…
Fantastic op-ed in today's @latimes from Dylan McClelland.
On ghost rates, McClelland captures the issue perfectly: "The insurers supplied the contracts, calculated the median and then pointed to the resulting figure as evidence of the 'market' rate. They were, in effect, grading their own exam."
latimes.com/opinion/story/20…
#NoSurprisesAct #BigInsurance #fairIDR #medtwitter #patients #healthcare @BmapGovt
🧵 Big Insurance's national trade group, @AHIPCoverage, has been running this ad each day in POLITICO's @playbookdc.
We didn't want to let this propaganda go unanswered.
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Second, AHIP claims "billions in wasteful spending." This couldn't be further from the truth. These billions are not wasteful. They represent a market correction that addresses years' of health plans' under- and non-payment to medical providers.
And when health plans lose at IDR, many times they are not even "spending" the money! In 2024, one survey showed that 59.6% of IDR awards were not paid with the law's required 30-day time frame. And to think you're lucky if you get paid late. Approximately 30% of awards are never paid at all.
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Finally, AHIP says "Americans are footing the bill." Again, that's propaganda meant to scare policymakers and plan enrollees. The truth? Peer reviewed research conducted by Harvard-affiliated researchers in @bmj_latest found that patients save an average of $567 per year under the No Surprises Act, with no measurable premium increase.
Yet, the health plans continue to generate billions in profits each quarter. And 276 ACA marketplace insurers are proposing a median premium hike of 15% next year--with increases as high as 54%.
Given the fact that total spend on IDR awards is roughly 0.3% of national healthcare spending, the fact the plans some how think we should believe that physicians, ASCs, hospitals, and other medical providers accessing a fair and reasonable IDR process are the culprits is what's actually egregious.
Americans are footing the bill for billions of dollars of health plans' share buybacks, eight-figure compensation packages for their executives, and stadium naming rights. If you watch the Buffalo Bills at home this fall, remember they're playing at Highmark BlueCross BlueShield Stadium.
The No Surprises Act, meanwhile, is busy protecting Americans from surprise medical bills. The law doesn't need to be gutted as AHIP is insisting with this ad. It needs to be strengthened by holding health plans accountable to their behavior.
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