HaloMD, a company formed in 2022 to help providers navigate the No Surprises Act's (NSA) independent dispute resolution (IDR) process, has become one of the most controversial players in U.S. healthcare billing. Representing over 150 medical groups and initiating roughly 21% of all annual IDR disputes, the company boasts a 90%+ win rate and secures median payouts more than nine times above in-network rates — making it a prime target for insurers and reform advocates alike.

In a wide-ranging interview, HaloMD's chief external affairs officer Patrick Velliky pushed back on critics, arguing that existing research on IDR costs lacks a proper baseline — specifically, what out-of-network care cost before the NSA. He published a study claiming the law has cut out-of-network emergency medicine spending by billions, though researchers flagged methodological concerns, including his reliance on in-network rate proxies and the exclusion of administrative costs and non-emergency specialties.

Velliky also addressed reform proposals, acknowledging that outlier arbitration awards and arbiter financial incentives deserve scrutiny, while defending HaloMD as a necessary equalizer for small, independent medical groups.

Key Takeaways:

• Velliky argues IDR cost analyses are misleading without a pre-NSA spending baseline for comparison
• He supports delinking arbiter payment from eligibility decisions to reduce perverse incentives
• HaloMD plans to partner with a third-party firm to replicate its findings with fewer assumptions

Why it matters: The NSA's IDR process was designed to protect patients from surprise bills, but its ballooning costs and contested outcomes have sparked bipartisan calls for reform. How policymakers respond could reshape reimbursement dynamics for providers and insurers nationwide.