Insurers’ Refusal to Negotiate Increases Arbitration Cases
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Securing fair physician reimbursement has become increasingly complex, adding yet another layer of administrative pressure to already demanding clinical responsibilities. Practices across the state continue to face delayed or inadequate payments from insurers, forcing physicians to spend valuable time resolving payment disputes rather than focusing on patient care.
In a recent article in Crain’s New York Business, MSSNY Executive Vice President Dr. Thomas Lee noted that the rise in arbitration filings reflects deeper payment challenges facing physicians across the state. According to Dr. Lee, when insurers fail to negotiate adequate payment for services delivered, physicians are often forced to turn to independent dispute resolution as the only viable pathway to recover reimbursement that supports practice operations.
Dr. Lee further noted that most physician practices are already stretched thin. Administrative capacity is limited, and physicians remain focused on what matters most: providing care to patients. As he emphasized, expecting physicians to personally manage complex arbitration processes without additional support is unrealistic, particularly when staffing shortages and regulatory burdens continue to intensify. In many cases, practices rely on specialized billing or support services to manage these disputes so physicians can continue delivering timely care. “Physicians are busy taking care of patients,” Lee said. “It’s only reasonable that they hire a billing company.”
MSSNY remains committed to supporting New York physicians facing these pressures. Through advocacy efforts, policy engagement, and strategic partnerships, MSSNY works to ensure physicians have access to resources that help manage reimbursement challenges while preserving time for patient care. These efforts reflect MSSNY’s continued role as the voice of New York physicians, working to protect the viability of practices and maintain access to care for patients statewide.
In a surprise to nobody, health insurers are seeking to flip the script, accusing physicians of flooding the state and federal IDR systems with claims. Physicians must respond to these unfair and outrageous accusations. Please urge your legislators to reject a Budget proposal that would completely upend the rules for the determination of claims brought to New York’s Independent Dispute Resolution (IDR) process for emergency care provided to patients by a non-participating physician. It would also eliminate the right of healthcare providers to even bring claims for IDR consideration related to care provided to enrollees of Medicaid Managed Care plans. These profound changes will lead to steep health insurer payment cuts, and harm patient access to urgently needed care by decreasing already limited on-call specialty care in hospital emergency departments.
