Providers Win in Most Disputed Surprise Billing Cases

The U.S. Department of Health and Human Services Center for Consumer Information and Insurance Oversight (CCIIO) released data March 18, that reveals providers prevailed in most reimbursement disputes during the first six months of 2024. The independent dispute resolution (IDR) process was instituted by the No Surprises Act to resolve disputes between providers and payers for certain out-of-network claims, with no effect on patients.

Emergency department and radiology claims made up 64% of the disputes. Providers won in approximately 84% of cases, which indicates a pattern of payers undervaluing the care provided to patients. Approximately 65% of the claims involved Aetna, Anthem, Cigna or United Healthcare.

Overall, the number of IDR disputes increased Jan.–June 2024, compared to the last six months of 2023. The number of disputes found to be ineligible for the IDR process declined from 22% in 2023, to 18% in 2024, which reflects process improvements and greater familiarity with eligibility requirements.

For more information about the No Suprises Act and the IDR process, contact Katie Keysor, American College of Radiology® Senior Director of Economic Policy.