A new lawsuit filed by UnitedHealthcare (UHC) against Radiology Partners, the largest radiology group in the U.S., exposes the growing tension between payers and providers under the No Surprises Act (NSA). Beneath the headlines, there’s a message every plan sponsor needs to hear: regulatory protections won’t stop aggressive billing tactics unless your plan is structured to defend itself.
The Case: Weaponizing the Dispute Process?
UHC alleges that Radiology Partners manipulated provider contracts to exploit the NSA’s independent dispute resolution (IDR) process. According to the lawsuit, Radiology Partners rerouted services from in-network facilities through an out-of-network entity, Sonoran Radiology, then used the IDR process to demand inflated payments from the insurer.
Radiology Partners denies wrongdoing and claims UHC is retaliating for losing arbitration cases. Either way, this legal battle highlights how the NSA, meant to protect patients, has become a high-stakes venue for financial maneuvering.
What It Means for Employers and Self-Insured Plans
This case isn’t just about two healthcare giants clashing in court. It underscores a critical risk for self-insured employers, your plan could be caught in the crossfire of billing disputes you didn’t see coming.
Here’s why:
- NSA disputes typically involve emergency room claims and claims by non-network providers at in-network facilities.
- The IDR process is complex and increasingly litigious, especially when claim costs are in the millions of dollars.
- The NSA protects participants while plan sponsors remain financially responsible, even when disputes involve vendor behavior.
If your plan isn’t built with protective strategies like Reference-Based Pricing (RBP), strong reimbursement logic and legal representation for claims disputes, you’re exposed.
How aequum Protects Your Plan From Getting Burned
aequum’s services are designed to close the gaps that cases like this expose:
- Legal support for billing disputes to prevent abusive use of the NSA process.
- NSA compliance and IDR representation to ensure claims are properly challenged, all rights preserved and protected during any enforcement.
- Reference-Based Pricing strategy to pre-emptively limit exposure to arbitrary out-of-network pricing.
- Claims audits and overpayment recovery to claw back funds from inflated or improper charges.
While plan sponsors must defend their health plan from unscrupulous and opportunistic claims designed to abuse the NSA’s participant protections, plan sponsors who don’t fully protect the plan’s rights, lose. In short, aequum walks with the plan sponsors through the NSA process to ensure your health plan is defensible, compliant and transparent … and not an easy target
The Takeaway: Don’t Rely on the Law to Protect You
The No Surprises Act was supposed to fix surprise billing. Instead, it has created a murky and confusing space and allowed providers to take advantage of a broken process. Employers shouldn’t assume the government will shield their plan from financial harm.
aequum gives you the tools and support to stay ahead of billing abuse, compliance failures and runaway costs.
Contact us today to review your plan’s exposure and make sure you’re not the next one stuck in the middle