A federal judge in Georgia just dismissed, with prejudice, the third insurer lawsuit this year accusing a billing intermediary of gaming the No Surprises Act’s arbitration process. Same result in California. Same result in Texas.
The insurers’ argument has been consistent: high provider win rates in arbitration are evidence of a rigged or abused system. CMS’s own data shows the scale of those wins. Analyzed across 2023 and 2024, the median payment determination in disputes won by providers ran 327% of the qualifying payment amount (QPA) in 2023, rising to 445% in 2024. In disputes filed specifically by HaloMD, the defendant in this case, the median award was 934% of QPA. Providers won roughly 80% to 85% of all determinations across both years.
The Georgia court looked at those same numbers and read them differently. It found it at least as plausible that the insurer’s own pattern of lowball initial offers — not provider fraud — explains why arbitrators keep siding with providers. QPA, by design, is the insurer’s own median 2019 in-network rate, indexed for inflation. If your opening offer sits well below your own historical benchmark, losing repeatedly in arbitration isn’t proof the other side is cheating. 𝗜𝘁 𝗺𝗮𝘆 𝗷𝘂𝘀𝘁 𝗯𝗲 𝗽𝗿𝗼𝗼𝗳 𝘆𝗼𝘂𝗿 𝗼𝗽𝗲𝗻𝗶𝗻𝗴 𝗻𝘂𝗺𝗯𝗲𝗿 𝘄𝗮𝘀 𝘁𝗼𝗼 𝗹𝗼𝘄 𝘁𝗼 𝗯𝗲𝗴𝗶𝗻 𝘄𝗶𝘁𝗵.
However, it’s worth measuring this against pre-NSA norms. A JAMA Health Forum study found average out-of-network payments ran about 112% above QPA — roughly double the benchmark, with no arbitration process at all. That’s a mean, not a clean match to the medians cited above, but the gap is hard to miss: today’s awards sit well past that older baseline. If the law’s goal was to pull out-of-network payments closer to in-network rates, the trend — this case included — is moving the other way.
For self-funded plan sponsors, this isn’t academic. NSA-related legal fees and “cost containment” charges tied to IDR disputes often show up in ASO administrative pricing without much explanation of the underlying theory. When that theory has now lost in three separate federal courts, plan fiduciaries have a legitimate reason to ask their carrier or TPA exactly what they’re being charged for.
None of this means both sides can’t be right in their own way. The court didn’t rule that award levels are reasonable — it ruled that it has almost no authority to second-guess what an arbitrator already decided. That’s a narrow, technical limit on judicial review, not a verdict on cost. If insurers want a different outcome, the data above suggests the fix isn’t more lawsuits attacking the process after the fact — it’s better-supported offers going into arbitration in the first place, where the case can still be won on the merits.
https://www.beckerspayer.com/legal/judge-dismisses-another-no-surprises-lawsuit-from-elevance/
