The Hill opinion and the dispute it describes
On August 13, 2026, The Hill published Big Insurance is trying to gut the No Surprises Act, an opinion contribution by healthcare attorney Mohamed H. Nabulsi. The Hill identifies contributor views as the author's own. Nabulsi argues that major insurers are using litigation, public advocacy, low initial offers, and resistance to payment determinations to weaken the law's provider-payment framework.
The Hill contributor's arguments should be read as advocacy, not as neutral findings by a court or federal agency. Halkovich Law's analysis below considers the operational issues those arguments raise for providers. It does not assume that every allegation applies to every payer, claim, or dispute.
What the federal data establish—and what they do not
The federal Independent Dispute Resolution process applies to certain out-of-network payment disputes after open negotiation does not resolve the matter. The Centers for Medicare & Medicaid Services publishes public-use files and operational reports on dispute volume, closure reasons, and payment determinations. Those records provide a stronger foundation for systemwide measurements than any party's characterization of the process.
Current federal materials show a process operating at a much larger scale than originally projected, with providers prevailing in a substantial majority of decided disputes. The Congressional Budget Office has also emphasized that evidence about price, network, and premium effects remains incomplete and that more research is needed. High provider win rates may support scrutiny of initial payments, but they do not by themselves prove improper conduct in a particular claim.
Why initial payment offers matter before arbitration
The opinion argues that some insurers make zero-dollar or very low initial offers and then criticize the size of later IDR awards. Whatever the broader motive, the initial payment is an important claim-level data point. It should be preserved alongside the EOB, QPA disclosure, eligibility explanation, payer rationale, and comparable payment history.
A low initial offer is not, by itself, proof of a statutory violation. It can nevertheless affect negotiation strategy and highlight the need to understand the payer's calculation. Providers should compare similar services over time, document recurring patterns, and connect the requested amount to evidence permitted under the rules instead of relying on generalized fairness arguments.
Litigation risk and award enforcement are separate questions
The Hill opinion discusses insurer lawsuits challenging providers, IDR administrators, and payment determinations. The procedural history and outcome of each case depend on its pleadings, forum, parties, and governing law. A dismissal in one dispute does not establish that all comparable claims are valid, and an insurer's filing does not establish that a provider acted improperly.
Providers should also distinguish winning an IDR determination from receiving the required payment. Post-award work requires its own file: the determination date, payment deadline, invoice or demand, amount received, remittance detail, shortfall, and every follow-up communication. That record helps counsel determine whether the remaining problem is administrative delay, a calculation dispute, nonpayment, or a broader enforcement issue.
What the proposed enforcement legislation would address
The opinion supports the No Surprises Act Enforcement Act. The related House and Senate proposals—H.R. 4710 and S. 2420—would add enforcement and reporting measures, including provisions addressing late or missing payments after a determination. Congress.gov lists both measures as introduced bills. They are proposals, not enacted law, as of August 14, 2026.
Providers should therefore follow the law and agency rules currently in effect while monitoring legislative developments. A proposed remedy may show where policymakers see an enforcement gap, but it does not create a present claim or extend an existing deadline.
Practical steps for healthcare providers
- Preserve EOBs, remittance records, QPA disclosures, and eligibility explanations for each affected claim.
- Keep open-negotiation notices, proof of delivery, payer offers, and the stated rationale for each offer.
- Track initiation, response, submission, determination, and payment dates against the applicable deadlines.
- Document training, experience, acuity, case complexity, and other claim-specific evidence relevant under the governing rules.
- Maintain post-award invoices, remittances, deposits, shortfall calculations, and correspondence in a separate enforcement record.
- Compare recurring payer and service patterns without assuming that one claim's outcome controls another.
- Escalate time-sensitive eligibility, batching, payment, or litigation issues before procedural rights expire.
The strongest provider response is usually a disciplined record. It allows counsel to separate eligible disputes from weak or untimely ones, present supported offers, and identify when a payment problem continues after the merits decision.
Where legal review fits
Legal review can connect public developments to a specific claim population. That includes determining which federal or state process applies, whether open negotiation was timely, what the payer disclosed, which evidence can support an offer, and whether a post-determination issue warrants further action.
The public debate may change quickly. The practical objective remains stable: preserve the record, protect deadlines, distinguish disputed assertions from established facts, and choose the forum that matches the claim.