Public payer-provider fights increase nearly 70%

Contract negotiation disputes between payers and providers that were reported in the media increased 69% between 2022 and 2023, and the number of communities affected across the country grew as well, according to data published Jan. 16 by FTI Consulting.

"Disputes between payers and providers continue to increase, with more individuals, families, and increasingly seniors being impacted due to a rising number of disputes involving Medicare Advantage plans," Citseko Staples Miller, managing director of FTI's healthcare and life sciences public affairs segment, told Becker's.

FTI has tracked media reports regarding negotiations over reimbursement rates between provider organizations and insurance companies during each quarter since early 2022.

Negotiations reported in the media on or after Jan. 1, 2023 or later were included in the data. Negotiations that were resolved or did not reach an agreement in 2023, but were first reported in 2022, were counted for 2022's data. If a provider dropped all Medicare Advantage contracts, FTI counted the decision as a single dispute.

FTI previously told Becker's that going public with contract negotiations is becoming a more common tactic for healthcare executives, but regulations also require patients to be notified when a network break may occur. 

Five notes:

1. In 2023, at least 86 disputes were covered in the media, compared to 51 in 2022, or a 69% increase.

2. Public disputes occurred across 34 states in 2023, compared to 24 states during 2022.

3. In 2023, 44% of public disputes failed to reach an agreement, and patients/members went out of network. In 2022, 45% of disputes did not reach a timely agreement.

4. Among the 86 disputes that went public in 2023, 59%, or 51, involved Medicare Advantage contracts. Twelve disputes were exclusively about MA plans.

5. In 2022, 29 of 51 public disputes, or 56%, involved Medicare Advantage contracts, with eight disputes exclusively involving MA plans.

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