Payer contracting & rates

CMS ousts 2 No Surprises arbiters as critics question impartiality

Earlier this week, the Trump administration denied recertification requests from Island Peer Review Organization and Network Medical Review Company. Insurers cheered the decision, though both arbiters said they were considering appeals.

Court rules for Jefferson Health in denying closed-door arbitration of Aetna’s ‘level of severity’ policy, affirming AHA’s legal position

Fix the No Surprises Act, Don’t Dismantle It

Congress can preserve the law's hard-won consumer protections while making targeted reforms to the independent dispute resolution system.

3 New Jersey Jefferson Health hospitals could leave Horizon BCBS

Insurers, employers urge CMS to pause No Surprises arbiter recertifications

The Coalition Against Surprise Medical Billing and the ERISA Industry Committee are asking the CMS to stop approving arbiters until it implements more rigorous standards.

Doctor cuts by UnitedHealthcare leave Villages Medicare Advantage patients in limbo

Judge denies Aetna’s bid to force Jefferson into arbitration over Medicare Advantage reimbursement policy

Ballad Health, UnitedHealthcare reach agreement over Medicare Advantage plans

CRFB Analysis Finds Anticompetitive Hospital & Provider Contracts Driving Healthcare Costs Higher

Oklahoma system out of network with Aetna, affecting 15,000 people