Radiologists criticize congressman’s proposed No Surprises Act shakeup
A U.S. congressman is proposing shaking up the No Surprises Act, a move that’s drawing widespread criticism from radiologists and other physicians.
Rep. Frank Pallone Jr., D-N.J., ranking member of the House Energy and Commerce Committee, on Thursday introduced the Lower Premiums, Faster Payments Act. The bill would eliminate the landmark legislation’s baseball-style arbitration process used to settle disputes between payers and providers over out-of-network healthcare services.
Pallone, instead, wants to move to a “fairer payment system,” based on the median in-network rate, requiring that insurers issue payment within 30 days of a claim being filed.
“A few bad actors—largely backed by private equity—are gaming the system, creating backlogs, delaying payments and driving up premiums,” Pallone said in a statement Oct. 8. “The Lower Premiums, Faster Payments Act will replace the broken arbitration system with a fair and timely payment process that lowers people’s health insurance premiums.”
Rep. Pallone was one of the original authors of the bipartisan No Surprises Act. He believes the legislation has since been an “overwhelming success” in protecting patients from unexpected medical bills. However, the congressman noted that “a small number of organizations”—mostly backed by private equity—account for the “overwhelming majority of disputes.” Out of 2.5 million submissions last year, about 67% came from 10 different provider groups.
An analysis published by Health Affairs in August cited Radiology Partners, the country’s largest imaging group, as the No. 1 initiator of disputes. The Nashville-based, investor-backed organization accounted for about 30% of resolved disputes between 2023. Pallone cited the Georgetown study—which was widely criticized by physician groups as skewed in the favor of payers—in making his case for the legislation.
The lawmaker noted that the arbitration process contributed an estimated $22.4 billion in total costs to the healthcare system over four years. For the New York State Employee Plan, these arbitrator awards purportedly contributed to a 10% premium hike in 2026.
“To help make healthcare more affordable, Congress needs to close the loopholes in existing law that private equity-backed and corporate firms are exploiting to secure inflated payments—loopholes that ultimately push premiums ever upward,” Anthony Wright, executive director of Families USA, a consumer health advocacy and policy organization, said in the announcement from Pallone. “While the bipartisan No Surprises Act continues to successfully protect patients from unexpected out-of-network medical bills, we need congressional action to prevent premium increases due to corporate middlemen abusing its arbitration process.”
Provider response
Provider groups including the American College of Radiology bashed the lawmaker’s proposal late Thursday.
ACR issued a joint statement with the American Society of Anesthesiologists and the American College of Emergency Physicians—three specialties adversely impacted by out-of-network care—calling the proposal “premature.” That’s because major federal reforms and court-ordered changes to the No Surprises Act have not yet fully been implemented.
Radiologists and other physicians warned that, if passed, the legislation would remove a “critical” independent safeguard against “unreasonably low” insurer payments. This while rewarding the “very insurance company practices that have contributed to problems with the law’s implementation.”
To back their claims, the medical societies cited their own analysis of available No Surprises Act data, sent to Congress in September. It shows that insurance companies have failed to even participate in the independent-dispute resolution process about 25% of the time. Insurers submitted offers of $1 or less on 8% of line items, and nearly 40% of payer offers were at or below the “qualifying payment amount”—a benchmark, in-network rate.
“Insurers cannot undermine the dispute-resolution process and then point to the resulting problems as justification for eliminating it,” Dana Smetherman, MD, MBA, the ACR’s chief executive officer, said in a statement Thursday. “Independent arbiters routinely reject insurers' unreasonably low payment offers. Eliminating arbitration would remove an important check on insurer conduct and threaten the ability of community-based and hospital-based physician practices to negotiate reasonable payment arrangements.”
ACR and the other medical societies also charged that constructive discussions are already underway in Congress on bipartisan approaches to improve arbitration. Potential solutions have included strengthening enforcement when insurers fail to pay awards, reducing the number of ineligible claims that enter the process, improving transparency, and addressing any unusually large payment awards. The three doc groups have previously pushed for the No Surprises Act Enforcement Act, which would accomplish these goals.
“None of these improvements requires abandoning independent arbitration or giving insurers greater control over physician payments,” radiologists, anesthesiologists and emergency docs charged in their statement. “Patients are protected from surprise bills. Now Congress must ensure that the payment dispute process works fairly for everyone—not just insurance companies,” they added later.
Ed Gaines—VP of regulatory affairs for Zotec Partners and an attorney who has advised provider groups on NSA issues—also criticized the proposed legislation Thursday. He called eliminating the arbitration process a “trainwreck for physicians and hospitals,” noting that the requirement to pay within 30 days comes with zero penalties or interest charged.
“As I have cited so many times here [on social media], the data is overwhelming that the plans are in systemic noncompliance with payment,” Gaines wrote on X.com. “Why would they comply in the future without enforcement, penalties or interest?”
Gaines also criticized the legislation for failing to include a “judicial review” of the qualifying payment amount, calculated by insurers. This will leave health plans with the “ultimate and unquestionable power” to set artificially low payment rates and never face questioning from physicians or hospitals in court.
“To the physician and supporting community—time to get ready to become active again to preserve and enhance the [No Surprises Act],” Gaines wrote. “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.”
In comments on Gaines original post, one radiologist—who posts anonymously under the handle @WillyRontgen—also noted that Rep. Pallone has taken over $360,000 in campaign contributions from insurance companies and their advocacy groups, according to ProPublica.
“He’s bought and paid for,” the radiologist responded to Gaines.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.