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Employers are increasingly frustrated with payors, citing mismanagement of self-funded plans as a growing concern.
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District courts are split on enforcing arbitration awards under the No Surprises Act (NSA), with New Jersey affirming enforcement via the FAA, while Texas rejected it, citing a lack of explicit congressional authorization. Appeals and pending regulations leave the legal landscape uncertain.
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Biden’s prior authorization reforms aim to reduce care delays and administrative burdens but face criticism. Providers want stricter insurer oversight, while insurers seek accountability for unnecessary care. Both sides call for further regulatory and legislative action
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Insurers' claim denials increase costs, delay care, and harm patient outcomes, but many patients are unaware they can appeal, highlighting the need for stricter enforcement and awareness efforts
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Multiplan faces a consolidated class action lawsuit alleging antitrust violations for suppressing out-of-network provider pay, potentially breaching the Sherman Act.
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