Halo MD

05/28/2026

A Texas federal court has dismissed Blue Cross Blue Shield of Texas's lawsuit against HaloMD.

The court affirmed that the No Surprises Act does not permit judicial review of Independent Dispute Resolution awards, and that the damages theory at the heart of the case fell outside the statute's framework.

The IDR process was designed to keep patients out of payment disputes and to resolve out-of-network billing through a structured, neutral arbitration system. The decision reinforces that the framework is working as Congress intended.

HaloMD will continue to support providers across the country in using the IDR process to obtain fair reimbursement for the care they deliver.

Read the Becker's Payer coverage: https://hubs.la/Q04j7dc00

HaloMD is the #1 provider of IDR services as indicated by CMS PUF. Backed by industry leading technology infrastructure and data intelligence.

A Texas federal court has dismissed a Blue Cross and Blue Shield of Texas lawsuit against independent dispute resolution company HaloMD. The lawsuit, filed in 2025, alleged HaloMD, which focuses on the provider side of IDR disputes, formed a scheme to exploit the arbitration process. BCBS Texas, und...

04/30/2026

The insurance industry argues the No Surprises Act unfairly favors providers. The data tells a different story.

In a new analysis, Patrick Velliky, Chief External Affairs Officer at HaloMD, examines the volume claims insurers have built their narrative on and finds the math does not support them.

Of the roughly 19.7 million commercial claims subject to the NSA in 2025, only 6.2% were submitted to Independent Dispute Resolution. After eligibility determinations and provider wins, insurers were required to pay more than their initial offer in just 4.4% of NSA-covered claims.

The real insurer win rate is over 95%.
IDR is being used judiciously, initiated by providers correcting documented underpayments, not as the runaway process insurers describe. Strengthening the No Surprises Act means streamlining the process and enforcing compliance, including passage of the NSA Enforcement Act (H.R. 4710 / S.2420).

Read the full analysis from Patrick: https://hubs.la/Q04dWK8P0

The insurance industry wants policymakers to think the NSA unfairly favors doctors. Their own data proves otherwise.

04/29/2026

22% of 2023 IDR awards owed to providers — still unpaid.
50% of 2024 payments missed the statutory 30-day window.
15% were paid in the wrong amount.

That's the data behind the coalition letter the California Medical Association and dozens of physician organizations sent to Treasury, Labor, and HHS this week — calling for stronger enforcement of the No Surprises Act and audits of how Qualified Payment Amounts are being calculated.

The No Surprises Act was designed to take patients out of the middle of payment disputes and establish a process for providers to receive fair and reasonable reimbursement. When IDR determinations go unpaid, get reopened, or are reconciled at the wrong amount, that process breaks down — and the law fails to do what Congress intended.

We're tracking this closely. Federal enforcement on payment timelines and QPA transparency will define provider economics for the rest of 2026.

Read the coalition's full case in the CMA write-up: https://hubs.la/Q04dSbY50

CMA joined a coalition of physician organizations urging federal regulators to crack down on health plans that are undermining the No Surprises Act by shifting costs onto patients, delaying payments ...

04/17/2026

Another federal court has affirmed what providers already know: the IDR process works as Congress intended.

A U.S. District Judge in Florida dismissed CVS-Aetna's lawsuit against Radiology Partners with prejudice, rejecting the insurer's attempt to unwind IDR outcomes through litigation. The court made clear that objections to arbitration results belong inside the process, not in federal court after the fact.

This follows a similar dismissal of an Anthem affiliate's lawsuit filed against HaloMD.
The pattern is hard to ignore. When independent, government-approved arbitrators consistently rule in favor of providers, some payers are choosing courtrooms over contracts. Courts are responding with a consistent message: the No Surprises Act created a defined framework. Use it.
Fair reimbursement is not fraud.

Providers exercising their rights under federal law is not a scheme. And the IDR process is not something to be undone when the outcome is inconvenient.

The path forward is straightforward: good-faith negotiation, sustainable contracts, and a shared commitment to the patients and communities that depend on both sides getting this right.

"This case reflects a troubling pattern in which payers, dissatisfied with IDR results, increasingly try to attack those outcomes outside the framework Congress created," Rad Partners says.

04/13/2026

A landmark win for healthcare providers.

Today, the U.S. District Court for the Central District of California dismissed every claim Anthem Blue Cross brought against HaloMD and its co-defendants, rejecting a sweeping attempt to use RICO, ERISA, and state-law theories to collaterally attack the No Surprises Act and the Independent Dispute Resolution process.

The court's message was unmistakable: Congress designed IDR to be the final word on out-of-network payment disputes, not a launching pad for federal litigation every time an insurer doesn't like the outcome.

This ruling protects the integrity of the NSA, the providers who rely on it, and the more than 30 million patients it has shielded from surprise medical bills since 2022.

/PRNewswire/ -- Today, HaloMD celebrates a significant victory in the U.S. District Court for the Central District of California, after Magistrate Judge Karen...

01/01/2026

As 2026 begins, healthcare remains deeply personal.

Behind every claim, every regulation, and every reimbursement decision are healthcare providers delivering care to patients, families, and entire communities—often under real pressure.

Across the country, they are navigating rising costs, growing complexity, and a healthcare landscape where long-term sustainability is becoming harder to achieve. National reporting shows that nearly half of rural hospitals are operating at negative margins, and more than 200 rural hospitals have closed or eliminated inpatient services over the past decade, reducing access to care for millions of patients—particularly in rural communities.

At HaloMD, the focus is clear and unwavering: helping providers obtain fair and reasonable reimbursement so they can continue serving the communities that rely on them.

Sustainable healthcare depends on organizations being able to remain open, invest in their people, and be present for patients when care is needed most.

In the year ahead, the work continues with purpose:

Supporting stability in a challenging reimbursement environment

Applying expertise and data to bring clarity to complexity

Helping protect access to care by strengthening the foundation of care delivery

The work continues—with purpose, responsibility, and a focus on sustainability.

12/25/2025

Wishing a restful holiday season to healthcare providers and the teams behind the scenes who show up every day to help keep care accessible for the communities who need it most.

As the year closes, we’re grateful for the collaboration and shared commitment to strengthening the financial sustainability of healthcare—so providers can stay resilient and patients can continue to access care close to home.

Here’s to health, time with loved ones, and a strong start to the new year.

12/05/2025

HaloMD Expands Executive Leadership to Further Strengthen Industry Leading Data, Technology, and Compliance Operations as Independent and Rural Providers Continue to Face Operational Risk

HaloMD is accelerating its enterprise growth trajectory with the addition of three proven leaders across data strategy, integration, and legal operations. As independent and rural providers continue to face mounting financial and operational pressure, the market is turning to HaloMD for scalable intelligence, regulatory clarity, and predictable reimbursement solutions under the No Surprises Act.

By bringing in Nirnay Patel, Dan Heinmiller, and Brandon Huber, we’re further advancing the rigor, governance, and infrastructure required to support healthcare organizations operating in increasingly volatile reimbursement environments.

This leadership expansion reflects the heightened demand for next-generation data ecosystems, integrated operational workflows, and deep regulatory alignment — all foundational to sustainable performance for practices and hospitals nationwide.

Read the full announcement: https://hubs.la/Q03X6ztg0

11/27/2025

As we head into Thanksgiving, we’re taking a moment to appreciate the people who bring purpose to our work each day—our teams, partners, and the providers we support.

We hope this holiday gives everyone the chance to step back, recharge, and spend meaningful time with the people who matter in their lives.

Wishing you a restorative and memorable Thanksgiving.

11/07/2025

The past few weeks have been busy. We attended the Athenahealth Thrive Conference and the Becker’s CEO + CFO Roundtable. These events highlighted why our work matters.

Every conversation reinforced one truth: when providers can remain financially stable, patients keep access to the care they deserve. That’s the heartbeat of everything we do at HaloMD.

From panels to side-stage discussions, the HaloMD team has been sparking critical dialogue on how the No Surprises Act and Independent Dispute Resolution can create balance — protecting providers while preserving access for patients.

Grateful to be part of a team that leads with purpose, empathy, and a relentless commitment to sustaining access to quality healthcare.

11/02/2025

This recent article authored by Dr. Richard Heller, pediatric radiologist with Rad Partners, explores the structural incentives driving IDR volume and cost—offering a data-grounded look at how the system is evolving under the No Surprises Act.

HaloMD is honored to be included in this important discussion. Dr. Heller highlights how our work expands access to the IDR process for providers who might otherwise lack the resources or expertise to engage—underscoring that, despite insurer rhetoric, neither HaloMD nor most of our provider clients are backed by private equity.

We appreciate Dr. Heller’s balanced perspective and the clarity he brings to a complex issue shaping out-of-network reimbursement today.

Read the full article here:https://hubs.la/Q03RdnLh0

The No Surprises Act has protected patients from surprise medical bills. However, the law’s incentives for insurers acting as third party administrators to push providers out of network and under-reimburse for care drive wasteful spending that harms patients, plans, and providers.