Radiologists implore HHS to punish payers who undermine surprise-billing protections

Health insurers are undermining surprise-billing protections and placing physician groups in peril, radiology groups warned the Trump administration on Monday. 

Over 100 specialty societies and state medical associations wrote Health and Human Services and other departments to voice their frustration. They noted that the No Surprises Act, passed in 2020, was meant to both protect patients from unexpected medical bills while promoting fair contracting between insurers and physicians.

However, radiologists and other specialists are expressing “growing concern” that some payers are sabotaging the “careful balance achieved” by the legislation. Those signing the message included the American College of Radiology, Society of Interventional Radiology, American Society of Neuroradiology and numerous others. 

“Unfortunately, health plans are finding ways to circumvent the statute with harmful policies that shift costs onto patients and undercut independent physician practices, jeopardizing access to care in their communities,” the organizations wrote to the departments of HHS, Labor and Treasury April 27. “We strongly urge the departments to increase enforcement efforts and require greater transparency in the [independent dispute resolution] process.”

ACR et al. highlighted five examples of “problematic” payer conduct that physicians have reported. These include (1) inappropriately shifting costs to patients after losing payment disagreements to physicians and (2) improperly reopening closed cases based on faulty interpretation of June 2025 federal guidance. Payers also have (3) frequently labeled claims as ineligible for the IDR process, with little feedback on why. Plus, they often (4) fail to share details on how they calculate “qualified payment amounts” that are the basis of negotiations. And finally, physicians also report that insurers also are (5) delaying or refusing to issue reimbursement, after losing in arbitration. 

“These situations are simply unsustainable for many physician practices,” the radiology groups wrote. “As such, we urge the departments to enforce payment after IDR decisions under the statutory timelines and assess penalties for repeat offenders.”

Others signing the message included the American Medical Association, Medical Group Management Association, American College of Radiation Oncology, American Society of Nuclear Cardiology, and the Society for Cardiovascular Magnetic Resonance. The AMA also highlighted the letter in a news update published Tuesday, acknowledging that trying to address surprise billing has been a difficult and “complex undertaking.” 

“Fortunately, we believe that these issues can be addressed largely with increased enforcement and transparency,” the letter closed, adding, “We look forward to working with you to address these concerns to ensure that the NSA continues to protect patients from surprise medical bills while preserving the sustainability of independent physician practices.”

Meanwhile, in related No Surprises Act news, a California federal court recently dismissed racketeering claims Anthem had brought against physician practices who use the law’s independent dispute-resolution process. The major insurer had charged that doc groups were manipulating the process by “strategically submitting massive numbers” of claims into the process. However, the court “soundly rejected” the payers’ claims, the American College of Radiology reported to its members in an April 20 news update. 

And in even more NSA news, the Brookings Institution recently shared new data on the legislation, spanning 2024. It reported that arbitration awards for imaging averaged 767% of Medicare that year, nearly four times typical pre-law, in-network commercial prices (around 200% of Medicare). It also noted that a small number of firms account for the lion’s share of disputes, including Radiology Partners, which filed over 90% of imaging claims in 2024.