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18 HARTFORDBUSINESS.COM | OCTOBER 6, 2025 out-of-network providers are frustrated that, even after going through arbitration, insurers often fail to pay the amounts awarded. "This continues to occur despite the fact that the federal law, passed by a bipartisan Congress, requires payment within 30 days of issuance of the arbitration award," Merin said. "Having exhausted non-litigation efforts, these types of cases are a last resort in compelling payment of the outstanding awards." Playing hardball Dr. Gregory Shangold, a managing partner of Northeast Emergency Medicine Specialists and a past pres- ident of both the Connecticut College of Emergency Physicians and Connecticut State Medical Society, likened the indepen- dent dispute resolution process to Major League Baseball arbitration, where teams and players each submit proposals and an arbitrator decides which side prevails. In healthcare disputes, providers put forward the payment they believe is fair, while insurers offer their "qualifying payment amount," or QPA — essentially the insurer's median rate for a certain proce- dure. The arbitrator then picks one figure, with no middle ground. Shangold said that, initially in 2022, 83% of arbitration decisions favored the providers, and that has since increased to 86%. "And why is that? Because the QPA is artificially low," he said. Shangold's concerns echo findings in the recent Connecticut federal court decision, which described insurers as using a "low pay, late pay or no pay scheme" in the arbitration process. The court said that practice has become "widespread," pointing to numerous awards that were either unpaid or delayed, and noting how many providers have failed to receive timely compensation. On average, the court found, providers are owed nearly 150% more than what insurers initially offered. It also cited more than $20 million in arbitration awards that were either late-paid or not paid at all. "There's no teeth in the (No Surprises Act)," Shangold said. "There's no teeth that says, 'hey, you have to pay.'" He said insurers play hardball in the process because it allows them to hold onto and invest the money they should pay to providers. Chris Bond, a spokesperson for AHIP, the national trade association for health insurers, says providers also are at fault. "Congress designed the No Surprises Act to protect American patients from exorbitant, unfair billing practices, not to pad private equity-backed provider profits on the backs of patients," he said via email. "Research clearly shows that some provider groups are abusing the arbitration process intended to resolve surprise billing disputes, saddling American employers and consumers with billions of dollars in unnecessary costs." 'Bill collectors' Arnold Menchel, a partner in the Hart- ford-based law firm Halloran Sage and chair of the firm's healthcare practice, said the U.S. District Court decision in Connecticut represents "one more chapter, from the health- care providers' viewpoint, in their ongoing saga of trying to get health insurance companies to pay health- care providers what they are owed under the law." "The question has become, 'what happens if the insurer does not pay, or does not pay timely?'" he said. Stephen Cowherd, an attorney with Pullman & Comley who chairs that firm's health prac- tice, says people observing the disputes between health providers and insurers likely feel little sympathy for either side. "Who feels really sorry for the heart surgeon?" he asked, while adding, "who's really bearing the brunt and the burden of this law? It's clearly the provider." Cowherd said consumers have benefited from the No Surprises Act, as noted in the study published in August, while insurance companies making billions of dollars can drag out the administrative process to delay paying providers for months or even years. The providers, mean- while, remain unpaid while spending money to fight for what they believe they are owed. To fix the problem, Shangold said insurers' payment calculations need more transparency and Congress must clarify how the No Surprises Act should be enforced. "We don't want to be bill collectors with patients," he said. Connect with us today! 860-448-4295 NMLS #402928 From the day you open your doors to the day you pass it on, and every day in between. Let's grow your business, together! We're here for it! Arbitration Fight Continued from page 17 Stephen Cowherd Arnold Menchel Gregory Shangold TOM YORK, SIOR c: 860.416.2239 e: TYork@GomanYork.com w: gomanyork.com FOR SUBLEASE 101 East River Drive, East Hartford, CT "Riverview Square" Downtown Hartford Amenities Just a Short Walk Away For More Information Plug & Play Opportunity Up to 40,000 sq. ft. • Below Market Rent with Free FF&E! READ ABOUT CONNECTICUT BUSINESS NEWS ON OUR WEBSITE HARTFORDBUSINESS.COM