EP 543 Medical Arbitration Becomes A Profit Center - with Scott Bennett

Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine.Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA’s national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill.We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement.If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?