Sarah Cliff

This new law, by all accounts, did do a lot to solve the problem of surprise medical bills, so patients are no longer in the middle of these billing disputes between insurers and doctors.

But what we found is that doctors have been flooding this new arbitration system with millions of claims and getting paid rates much, much higher than they did in the past.

Each side submits what they think is a fair price for the medical care rendered.

They submit some arguments, and then the arbitrator selects one of them.

There is no middle ground.

Somebody is going to win.

And once the arbitrator picks someone, that is the final decision.

There is no route to appeal.

Sometimes the numbers that insurers and doctors bring to the table are wildly different.

There was one case that we looked at where the insurance company offered $2,600 for a test of blood flow to the brain.

The doctor asked for $330,000 and they won that dispute and got that money.

We saw this happening repeatedly in this massive data set that had millions of claims.

We saw gynecologists who were getting 600 times the normal rates for placing a contraceptive called an IUD.

And the doctors are overwhelmingly winning these disputes.

We found that in 88% of the cases, they win and they're often winning hundreds of times of what they used to get paid before this law passed.

One of the mysteries is why the results are so lopsided.

It surprised the lawmakers who wrote this law when we asked them about it.

There are a few theories.

One is that the arbitrators are paid on a per-case basis, so they have an incentive to render decisions favorable to doctors, to have doctors continue bringing them disputes.

Another is that doctors are just viewed more positively by the public than insurance plans are, and maybe arbitrators have those same kind of biases that the general public does.