INDUSTRY PERSPECTIVES

NSA – The Nightmares Continue

By Amy Pellegrin, Senior Vice President & Chief Legal Officer

The healthcare cost savings promised by the No Surprises Act still haven’t materialized.

This is despite another year of data, more implementation experience and additional guidance from federally appointed arbitrators.

The NSA nightmares we outlined a year ago persist, and there’s little advocacy for those bearing the actual costs.

Providers continue to flood the Independent Dispute Resolution process. The most recent data from the Centers for Medicare & Medicaid Services indicates a 40% year-over-year increase in filings. Why? Because it’s demonstrably good for their business: The initiating party wins disputes 88% of the time — a four-point increase compared to a year ago, making the situation even more inequitable and egregious.

Now, there’s a new battlefront.

How Dual Option Turned an RBP Skeptic Into an Advocate

Convincing consultants to bring reference‑based pricing to clients isn’t easy. Paul Saunders, executive vice president at Saunders & Company, knows firsthand as someone who once was “totally opposed” to RBP. That changed when he saw how a dual‑option approach could work: pairing a traditional health plan with a lower‑cost RBP option and letting members choose what fits them best.

In this month’s episode of ClaimTalk, Saunders joins ClaimDOC’s Omar Arif and Stephanie Mohr to explore how dual‑option plans help brokers address rising renewal costs without forcing employers into an all‑or‑nothing decision. They explore why offering choice may be the most practical path to affordability, client confidence and long‑term satisfaction.

Watch the episode

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Avenel, New Jersey

Hospital Bill $73,397.11

A two-day hospital stay for the treatment of a heart attack and related procedure.

	Plan	Member
Traditional Network Plan	$50,467.63 Median Commercially Contracted Price	$10,093.53 Patient Responsibility (20% Coinsurance)
DirectAccess+	$18,437.91 ClaimDOC Allowable	$3,687.58 Patient Responsibility (20% Coinsurance)
Savings	$32,029.72	$6,405.95

Read more audit examples

To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings.

Service Shoutout

"Riley has assisted me in nominating quite a few providers and has shepherded me through several medical processes. I am continually surprised at how quickly she responds — often within minutes. Her kindness, knowledge of this system and competent professionalism makes every other person I deal with over the phone or computer pale in comparison. She has my vote for whatever office she might run for."

Riley DeLong

INDUSTRY PERSPECTIVES﻿

NSA – The Nightmares Continue

How Dual Option Turned an RBP Skeptic Into an Advocate

INDUSTRY PERSPECTIVES