Texas physician group warns No Surprises Act enforcement gap is adding costs

By AI, Created 12:35 PM UTC, May 20, 2026, /AGP/ – Radiology Associates of North Texas says insurers are delaying or avoiding payment on binding arbitration awards under the No Surprises Act, creating unpaid balances and rising administrative costs. The group says current dispute-batching rules could push systemwide arbitration expenses above $51 million.

Why it matters: - Radiology Associates of North Texas says enforcement gaps in the No Surprises Act are weakening a federal process meant to keep surprise medical-bill disputes fast and final. - The group says unpaid arbitration awards and dispute-processing rules are adding avoidable costs for employers, health plans and patients. - The issue could affect the long-term credibility of the Independent Dispute Resolution process.

What happened: - Radiology Associates of North Texas, the largest independent physician-owned radiology practice in the U.S., said Blue Cross Blue Shield of Texas has not paid a large share of finalized IDR awards. - The group says it has prevailed in about 95% of finalized IDR disputes involving Blue Cross Blue Shield of Texas. - More than $3.5 million in awarded balances remains unpaid. - Nearly $1.64 million has been outstanding for more than 120 days. - Blue Cross Blue Shield of Texas has paid about 2% of awarded balances, according to RANT. - Dr. Kurt Schoppe, president of Radiology Associates of North Texas, said the awards are finalized federal determinations and should not remain unpaid without consequences.

The details: - The No Surprises Act, passed in 2019, was designed to protect patients from unexpected out-of-network medical bills. - Insurers and providers use federally managed Independent Dispute Resolution to settle payment disputes. - Arbitrators issue binding decisions intended to resolve those disputes efficiently and fairly. - RANT says current federal batching interpretations are forcing similar claims into far more arbitration filings than necessary. - Under RANT’s ideal batching model, the disputes would require about 1,369 batches and $1.05 million in administrative costs. - Under the current federal interpretation advocated by Blue Cross Blue Shield of Texas, the disputes would require about 68,450 batches and $52.7 million in administrative costs. - RANT says the projected increase is more than $51.6 million. - The federally mandated fees include a $115 administrative fee per batch and a $655 arbitrator fee per batch. - For a typical radiology claim averaging about $110, the administrative fees can exceed the service cost many times over. - Dr. Schoppe said those expenses ultimately flow back to employers and plan sponsors through higher overhead and healthcare costs. - The issue gained urgency after a recent Fifth Circuit Court ruling said providers do not have a private right of action under the No Surprises Act to enforce unpaid IDR awards.

Between the lines: - RANT is framing this as more than a payment fight with one insurer. - The group says the problem is a system-cost issue that could undermine the arbitration process Congress created. - The enforcement gap shifts pressure away from insurers and toward providers, employers and plan sponsors. - The batching dispute also shows how procedural rules can drive costs even when the underlying medical claim is modest.

What’s next: - RANT is urging federal legislation that would impose meaningful penalties on insurers that fail to comply with binding IDR payment determinations. - The group is also calling for updated CMS batching guidance to reduce unnecessary filing and arbitrator fees. - RANT says the issue extends beyond Texas, even though its dispute involves Blue Cross Blue Shield of Texas. - Dr. Schoppe said patients should remain protected and that the law only works if all parties follow the rules.

The bottom line: - RANT says the No Surprises Act is protecting patients in principle, but weak enforcement and dispute-processing rules are creating a costly gap in practice.