Halo MD

A Texas federal court has dismissed Blue Cross Blue Shield of Texas's lawsuit against HaloMD.

The court affirmed that the No Surprises Act does not permit judicial review of Independent Dispute Resolution awards, and that the damages theory at the heart of the case fell outside the statute's framework.

The IDR process was designed to keep patients out of payment disputes and to resolve out-of-network billing through a structured, neutral arbitration system. The decision reinforces that the framework is working as Congress intended.

HaloMD will continue to support providers across the country in using the IDR process to obtain fair reimbursement for the care they deliver.

Read the Becker's Payer coverage: https://hubs.la/Q04j7dc00

HaloMD is the #1 provider of IDR services as indicated by CMS PUF. Backed by industry leading technology infrastructure and data intelligence.

Court dismisses BCBS Texas lawsuit against HaloMD - Becker's Payer Issues | Payer News A Texas federal court has dismissed a Blue Cross and Blue Shield of Texas lawsuit against independent dispute resolution company HaloMD. The lawsuit, filed in 2025, alleged HaloMD, which focuses on the provider side of IDR disputes, formed a scheme to exploit the arbitration process. BCBS Texas, und...

The insurance industry argues the No Surprises Act unfairly favors providers. The data tells a different story.

In a new analysis, Patrick Velliky, Chief External Affairs Officer at HaloMD, examines the volume claims insurers have built their narrative on and finds the math does not support them.

Of the roughly 19.7 million commercial claims subject to the NSA in 2025, only 6.2% were submitted to Independent Dispute Resolution. After eligibility determinations and provider wins, insurers were required to pay more than their initial offer in just 4.4% of NSA-covered claims.

The real insurer win rate is over 95%.
IDR is being used judiciously, initiated by providers correcting documented underpayments, not as the runaway process insurers describe. Strengthening the No Surprises Act means streamlining the process and enforcing compliance, including passage of the NSA Enforcement Act (H.R. 4710 / S.2420).

Read the full analysis from Patrick: https://hubs.la/Q04dWK8P0

Insurers Prevail Under the No Surprises Act Framework over 95% of the Time. The insurance industry wants policymakers to think the NSA unfairly favors doctors. Their own data proves otherwise.

22% of 2023 IDR awards owed to providers — still unpaid.
50% of 2024 payments missed the statutory 30-day window.
15% were paid in the wrong amount.

That's the data behind the coalition letter the California Medical Association and dozens of physician organizations sent to Treasury, Labor, and HHS this week — calling for stronger enforcement of the No Surprises Act and audits of how Qualified Payment Amounts are being calculated.

The No Surprises Act was designed to take patients out of the middle of payment disputes and establish a process for providers to receive fair and reasonable reimbursement. When IDR determinations go unpaid, get reopened, or are reconciled at the wrong amount, that process breaks down — and the law fails to do what Congress intended.

We're tracking this closely. Federal enforcement on payment timelines and QPA transparency will define provider economics for the rest of 2026.

Read the coalition's full case in the CMA write-up: https://hubs.la/Q04dSbY50

CMA calls for enhanced federal oversight of No Surprises Act implementation CMA joined a coalition of physician organizations urging federal regulators to crack down on health plans that are undermining the No Surprises Act by shifting costs onto patients, delaying payments ...

Another federal court has affirmed what providers already know: the IDR process works as Congress intended.

A U.S. District Judge in Florida dismissed CVS-Aetna's lawsuit against Radiology Partners with prejudice, rejecting the insurer's attempt to unwind IDR outcomes through litigation. The court made clear that objections to arbitration results belong inside the process, not in federal court after the fact.

This follows a similar dismissal of an Anthem affiliate's lawsuit filed against HaloMD.
The pattern is hard to ignore. When independent, government-approved arbitrators consistently rule in favor of providers, some payers are choosing courtrooms over contracts. Courts are responding with a consistent message: the No Surprises Act created a defined framework. Use it.
Fair reimbursement is not fraud.

Providers exercising their rights under federal law is not a scheme. And the IDR process is not something to be undone when the outcome is inconvenient.

The path forward is straightforward: good-faith negotiation, sustainable contracts, and a shared commitment to the patients and communities that depend on both sides getting this right.

Judge dismisses CVS-Aetna’s lawsuit against Radiology Partners "This case reflects a troubling pattern in which payers, dissatisfied with IDR results, increasingly try to attack those outcomes outside the framework Congress created," Rad Partners says.

A landmark win for healthcare providers.

Today, the U.S. District Court for the Central District of California dismissed every claim Anthem Blue Cross brought against HaloMD and its co-defendants, rejecting a sweeping attempt to use RICO, ERISA, and state-law theories to collaterally attack the No Surprises Act and the Independent Dispute Resolution process.

The court's message was unmistakable: Congress designed IDR to be the final word on out-of-network payment disputes, not a launching pad for federal litigation every time an insurer doesn't like the outcome.

This ruling protects the integrity of the NSA, the providers who rely on it, and the more than 30 million patients it has shielded from surprise medical bills since 2022.

CALIFORNIA FEDERAL COURT DELIVERS LANDMARK VICTORY FOR HEALTHCARE PROVIDERS IN NO SURPRISES ACT DISPUTE /PRNewswire/ -- Today, HaloMD celebrates a significant victory in the U.S. District Court for the Central District of California, after Magistrate Judge Karen...