Latest
THE WATCH / NEWS & UPDATES
The failures. The fallout. The fight for care.
Follow the denials, delays and payment failures behind Big Insurance’s promises, and the efforts to hold insurers accountable. We track their consequences for patients and providers, with emergency air medical access at the core of our work.
Read the latest from Big Insurance Watch below. For deeper analysis and source materials, visit Watch Files.
IN THE NEWS
Coverage worth watching
Reporting, research and perspectives selected by BIW. These are outside sources, with original BIW summaries and links to the full material.
The dispute over surprise-billing arbitration
Physician organizations / Newswise • September 23, 2026 • Advocacy statement ACEP, ACR and ASA argue that insurer payment practices push physicians into independent dispute resolution. Their analysis sent to Congress calls for stronger enforcement and preservation of the No Surprises Act's dispute process. This is the organizations' position, rather than independent news reporting. Read the statement on Newswise →
Blue Shield fined over complaint delays
Becker's Payer Issues • Reporting by Elizabeth Casolo Becker's reports that California regulators fined Blue Shield of California $800,000 over failures that delayed member complaint resolution. Blue Shield told the publication it had taken corrective action and was strengthening its processes. Read Becker's reporting →
Kaiser, AI and access to mental health care
Local News Matters • September 3, 2026 • News reporting San Francisco supervisors urged Kaiser Permanente to limit AI in mental health services. The coverage follows a debate over proposed contract terms and the role of clinicians in care. Read Local News Matters →
What denial data can show, and what it cannot
KFF • January 27, 2025; updated March 24, 2026 • Research KFF's corrected analysis found that HealthCare.gov insurers denied 20% of in-network claims in 2023, while consumers appealed fewer than 1% of denied claims. The dataset covers post-service claims in specified Marketplace plans. It does not measure all health insurance or prior authorization denials. Read KFF's analysis and methods →
Source dates refer to the original material, not the date BIW selected it. Full articles remain with their publishers.
Ghost Rates: The Scariest Number in Health Care This Halloween
Insurers padded their No Surprises Act benchmark with prices for services no one provides, some as low as $0. A federal appeals court called the result "artificially low."
Last week we wrote about ghost networks: insurance directories full of doctors who are not really taking patients. This Halloween, meet their cousin, ghost rates.
Under the No Surprises Act, an insurer's "qualifying payment amount," or QPA, is supposed to reflect the median rate it actually pays in-network providers for a service. That number matters. It helps set what patients pay out of pocket, and it is the starting point when a payment dispute goes to a neutral arbitrator.
For years, insurers counted rates for services a provider never actually performs. A contract might list a price for a procedure that doctor has never done and never will, sometimes as low as $0. Those phantom prices went into the median and pulled it down.
In August, the full U.S. Court of Appeals for the Fifth Circuit ended the practice. The court found that ghost rates produced "artificially low QPAs" and struck them from the federal formula.
Federal auditors keep finding problems, too. CMS found Aetna of Texas calculating air ambulance QPAs from paid amounts instead of contracted rates. This month, auditors found CareSource substituted "usual and customary" rates in all 952 QPAs they sampled. Neither audit carried a financial penalty.
Why does this matter now? Because the newest proposals in Washington would make the insurer's number the final word. One bill would end arbitration and pay out-of-network care at the insurer's 2019 median rate plus inflation, with no neutral review. A think tank proposal would cap arbitration awards near the insurer's in-network rates. So when you hear that arbitrators award "four times the QPA," ask a simple question: four times what? Some of those benchmarks were built in part on rates that never existed.
The answer is not to hand the pen to the insurer. Keep the neutral referee. Make the insurer's numbers honest. And make sure that when an arbitrator rules, the award actually gets paid, which is what Rep. Greg Murphy's bipartisan No Surprises Act Enforcement Act (H.R. 4710) sets out to do.
Patients pay real premiums. They deserve real networks and real rates. Happy Halloween.
Sources
Texas Medical Ass'n v. HHS (TMA III), U.S. Court of Appeals for the Fifth Circuit, en banc, Aug. 11, 2026
CMS QPA audit reports: Aetna Health of Texas (2024) and CareSource (Oct. 2026)
H.R. 10788, Lower Premiums, Faster Payments Act (Pallone, Oct. 2026)
Paragon Health Institute, "Fixing the No Surprises Act" (Sept. 2026)
H.R. 4710, No Surprises Act Enforcement Act (119th Congress)