Incremental piecemeal laws like the “No Surprises Act” (passed in 2020) continue to fail patients.
(Elevance Health's Public Policy Institute. That's funny.)
For those who skim, read Wendell's full article >
Gail Boudreaux should be indicted, convicted and incarcerated by now.
Elevance paid the government more than $342 million to help settle allegations that it overcharged the federal healthcare program for years. Elevance sent the money to the Centers for Medicare & Medicaid Services via wire transfer on May 27, 2026, court records show.
Just days later on June 1st, Attorney General Kris Mayes announced a lawsuit against MultiPlan and several large commercial health insurance investment banks, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care. The lawsuit alleges that for years, MultiPlan and insurers Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation relied on a shared algorithm to decide how much to pay for out‑of‑network care, which relied in part on their collective sharing of confidential, competitively sensitive claims payment information with and through MultiPlan. Instead of competing or setting payments independently, they allegedly used the same formula and the same data, and delegated payment negotiation decisions to MultiPlan, resulting in extremely low payments across the industry that continued to decrease over time.
The commercial health insurance investment banks collude to architect crimes. This is price-fixing. Physicians attended the presser in Arizona to underline how much harm these crimes impose on physician practices and patients. These are not victimless crimes.
The corporatization of medicine has caused preventable harm and death for 40 years. The only solution to the failed approach to, and model of, healthcare policy in the United States of America is to pass Senate Bill 1506/HR 3069 — National Improved Medicare for All / Single Payer Universal Healthcare.
Visit THE FINE PRINT Magazine and "SOME PEOPLE" for more.
The statistic that providers prevail in roughly 90% of IDR disputes is technically accurate. But standing alone, it is also deeply misleading.
The far more important statistic is this: fewer than 5% of IDR eligible claims ever make it to arbitration.
That means insurers’ payment determinations stand on more than 95% of eligible claims without any independent review whatsoever.
So when insurers point to a 90% provider win rate, they are not describing the No Surprises Act as a whole. They are describing the tiny fraction of claims that survive a long, expensive, and administratively burdensome process to reach an independent certified IDR entity.
That distinction matters.
If providers were broadly “gaming” the system, we would expect far more than 5% of eligible claims to be submitted to IDR. Instead, most providers accept underpayments because pursuing arbitration requires filing fees, significant documentation, administrative resources, and the risk of losing.
The claims that do reach IDR are therefore not representative of all claims. They are the claims where providers believed the insurer’s payment was so unreasonable that the economics justified seeking independent review.
There is another piece of the story that rarely gets mentioned.
A significant number of provider “wins” occur because the insurer never submits an offer or otherwise fails to participate in the IDR process. Those determinations are not the result of an arbitrator choosing one well argued offer over another. They occur because one party chose not to participate in the process Congress established.
Those default determinations are then combined with fully contested cases and cited as evidence that providers are somehow exploiting the system.
That raises an important question.
If insurers truly believe these claims are defensible, why are so many allowed to result in default determinations?
The more important question is this.
When insurers do participate, and an independent certified IDR entity reviews both parties’ offers using all of the statutory factors Congress required, not just the QPA, why are insurer offers rejected so frequently?
Is that evidence the process is broken?
Or is it evidence that the relatively small number of claims reaching IDR are precisely the claims where insurers’ payment offers were least likely to withstand independent scrutiny?
If we are going to evaluate the No Surprises Act honestly, we have to look at the entire process.
Insurers prevail on more than 95% of eligible claims before any independent review ever occurs.
Only a tiny percentage of claims reach arbitration.
Some of the provider wins within that small percentage occur because insurers never participate.
Without that context, citing a 90% provider win rate is not a complete analysis.
It is a carefully selected statistic that tells only part of the story.
Why would anyone take the insurer's own "study" seriously? It's like the fox "studying" the hen house and saying the hens are the problem. Can't we have an independent auditor produce such a study?
Talk about drinking their own Kool-Aid. No one, most of all insurance companies, can actually believe their own dreck at this point. I don't know a single person who hasn't been f'd over by a health insurance company in one way or another.
Congress will take only incremental steps like the No Surprises Act unless and until we ban insurers and drug makers and all corporations from making campaign contributions. But SCOTUS already declared money is speech and cannot be restricted. Money is corruption, pure and simple. Big Money is Big Corruption. How we change this I have no idea. But my hands are itching for a pitchfork...
Another important thing to add as well is that most physicians are nowhere near this fight. Per CMS's own reports, a handful of private equity-backed physician management companies (plus one arbitration middleman) account for over half of all filings—the top ten account for nearly 70%. Most practicing doctors have never been near this process; many can't afford to be. So the arbitration story isn't really a "doctors’” story at all. It's a few corporate filing operations with physicians' names on the paperwork.
The other fix that seems overdue is the conflicts of interest inside the process itself. There are reports that PE firms back certified entities that arbitrate these disputes—including ownership that overlaps with the provider side bringing cases. This naturally would skew decision-making.
The era of Denial of Care Harm-for-Profit by commercial health insurance investment banks is coming to an end. Single Payer Universal Healthcare / National Improved Medicare for All will be passed.
Incremental piecemeal laws like the “No Surprises Act” (passed in 2020) continue to fail patients.
(Elevance Health's Public Policy Institute. That's funny.)
For those who skim, read Wendell's full article >
Gail Boudreaux should be indicted, convicted and incarcerated by now.
Elevance paid the government more than $342 million to help settle allegations that it overcharged the federal healthcare program for years. Elevance sent the money to the Centers for Medicare & Medicaid Services via wire transfer on May 27, 2026, court records show.
Just days later on June 1st, Attorney General Kris Mayes announced a lawsuit against MultiPlan and several large commercial health insurance investment banks, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care. The lawsuit alleges that for years, MultiPlan and insurers Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation relied on a shared algorithm to decide how much to pay for out‑of‑network care, which relied in part on their collective sharing of confidential, competitively sensitive claims payment information with and through MultiPlan. Instead of competing or setting payments independently, they allegedly used the same formula and the same data, and delegated payment negotiation decisions to MultiPlan, resulting in extremely low payments across the industry that continued to decrease over time.
The commercial health insurance investment banks collude to architect crimes. This is price-fixing. Physicians attended the presser in Arizona to underline how much harm these crimes impose on physician practices and patients. These are not victimless crimes.
The corporatization of medicine has caused preventable harm and death for 40 years. The only solution to the failed approach to, and model of, healthcare policy in the United States of America is to pass Senate Bill 1506/HR 3069 — National Improved Medicare for All / Single Payer Universal Healthcare.
Visit THE FINE PRINT Magazine and "SOME PEOPLE" for more.
The statistic that providers prevail in roughly 90% of IDR disputes is technically accurate. But standing alone, it is also deeply misleading.
The far more important statistic is this: fewer than 5% of IDR eligible claims ever make it to arbitration.
That means insurers’ payment determinations stand on more than 95% of eligible claims without any independent review whatsoever.
So when insurers point to a 90% provider win rate, they are not describing the No Surprises Act as a whole. They are describing the tiny fraction of claims that survive a long, expensive, and administratively burdensome process to reach an independent certified IDR entity.
That distinction matters.
If providers were broadly “gaming” the system, we would expect far more than 5% of eligible claims to be submitted to IDR. Instead, most providers accept underpayments because pursuing arbitration requires filing fees, significant documentation, administrative resources, and the risk of losing.
The claims that do reach IDR are therefore not representative of all claims. They are the claims where providers believed the insurer’s payment was so unreasonable that the economics justified seeking independent review.
There is another piece of the story that rarely gets mentioned.
A significant number of provider “wins” occur because the insurer never submits an offer or otherwise fails to participate in the IDR process. Those determinations are not the result of an arbitrator choosing one well argued offer over another. They occur because one party chose not to participate in the process Congress established.
Those default determinations are then combined with fully contested cases and cited as evidence that providers are somehow exploiting the system.
That raises an important question.
If insurers truly believe these claims are defensible, why are so many allowed to result in default determinations?
The more important question is this.
When insurers do participate, and an independent certified IDR entity reviews both parties’ offers using all of the statutory factors Congress required, not just the QPA, why are insurer offers rejected so frequently?
Is that evidence the process is broken?
Or is it evidence that the relatively small number of claims reaching IDR are precisely the claims where insurers’ payment offers were least likely to withstand independent scrutiny?
If we are going to evaluate the No Surprises Act honestly, we have to look at the entire process.
Insurers prevail on more than 95% of eligible claims before any independent review ever occurs.
Only a tiny percentage of claims reach arbitration.
Some of the provider wins within that small percentage occur because insurers never participate.
Without that context, citing a 90% provider win rate is not a complete analysis.
It is a carefully selected statistic that tells only part of the story.
Why would anyone take the insurer's own "study" seriously? It's like the fox "studying" the hen house and saying the hens are the problem. Can't we have an independent auditor produce such a study?
Talk about drinking their own Kool-Aid. No one, most of all insurance companies, can actually believe their own dreck at this point. I don't know a single person who hasn't been f'd over by a health insurance company in one way or another.
Congress will take only incremental steps like the No Surprises Act unless and until we ban insurers and drug makers and all corporations from making campaign contributions. But SCOTUS already declared money is speech and cannot be restricted. Money is corruption, pure and simple. Big Money is Big Corruption. How we change this I have no idea. But my hands are itching for a pitchfork...
Thank you hero Potter and especially Attorney General Kris Mayes of Arizona
Another important thing to add as well is that most physicians are nowhere near this fight. Per CMS's own reports, a handful of private equity-backed physician management companies (plus one arbitration middleman) account for over half of all filings—the top ten account for nearly 70%. Most practicing doctors have never been near this process; many can't afford to be. So the arbitration story isn't really a "doctors’” story at all. It's a few corporate filing operations with physicians' names on the paperwork.
The other fix that seems overdue is the conflicts of interest inside the process itself. There are reports that PE firms back certified entities that arbitrate these disputes—including ownership that overlaps with the provider side bringing cases. This naturally would skew decision-making.
July 9, 2026 / New York Times >>
The era of Denial of Care Harm-for-Profit by commercial health insurance investment banks is coming to an end. Single Payer Universal Healthcare / National Improved Medicare for All will be passed.
https://www.nytimes.com/2026/07/08/business/health-insurance-cvs-unitedhealth-breakup.html