Universal HealthcareBy NextBestFit
Problem · Affordability & medical debt

Surprise billing and a runaway arbitration system

The No Surprises Act protects patients from many surprise bills, but the arbitration process for provider-insurer disputes exploded to 1.42 million disputes in 2024 (versus 17,000 expected), mostly filed by private-equity-backed groups, and providers win about 85%. Ground ambulances are not covered.

Evidence

Who's affected

Who is hurt
Who gains while it lasts

Under your mix of paths

Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
  • Out-of-network billing
  • Separate payers disputing prices

Related costs

Open questions

  • Should payment disputes be eliminated by having one payment schedule?

Solution paths (2)

Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.

Set a default out-of-network rate instead of arbitrationChosen

Pay out-of-network bills at a fixed benchmark (e.g., a percentage of Medicare), ending the independent dispute resolution system.

  • +Surprise billing and a runaway arbitration system
  • −Reduces income or business for affected groups
  • −Providers leave, retire, or go cash-only if pay drops
Eliminate out-of-network statusChosen

With one payer or universal all-payer rates, there is no out-of-network.

  • +Surprise billing and a runaway arbitration system
  • +About $1 trillion a year in administrative cost
  • −Depends on other changes to work
  • −Providers leave, retire, or go cash-only if pay drops

Also addressed by paths for other problems

Single public payer for everyoneTens of millions of people have no coverageChosen

With one payer and one fee schedule, no provider is out of network, so there is no surprise bill.