The Office of the Insurance Commissioner (OIC) released a report of arbitration proceedings and results for 2020 under the state’s Balance Billing Protection Act (BBPA). The BBPA provides for arbitration in cases where a state-regulated insurer and a non-contracted provider cannot agree on the payment amount for specific services under the BBPA. The results will help inform our state’s decisions regarding implementation of the federal No Surprises Act (NSA), which involves a separate arbitration process. WSHA and member hospitals are actively engaged with OIC regarding NSA implementation and potential modifications to the BBPA.
According to the report, 71 separate arbitrations were filed in 2020, involving 835 claims. The filings involved emergency physician and anesthesiology services, with anesthesiology comprising the bulk of the arbitrated services. Of the 71 filings:
- 19 were rejected as not filed within the required time frame from the date of payment.
- 18 were settled by the parties or withdrawn before the arbitration decision.
- Of the 29 filings that went through the full arbitration process, nearly all involved United Health Care (UHC). In nearly all these cases the arbitrator ruled in favor of the amount filed by the provider group rather than the UHC proposed payment.
WSHA anticipates a significant amount of arbitration in 2021 involving radiology groups, given recent UHC contracting activity. (Andrew Busz, AndrewB@wsha.org)