Tom Sugarman, MD, FACEP, FAAEM

@EdGainesIII We, providers, want to be in network. If there were accurate QPAs and arbitration awards were paid, then insurance companies would come to the table to negotiate fair market based rates. Instead they profit by gaming the NSA & via noncompliance. Pass HR 4710.

Exhibit A for passage of the No Surprises Act Enforcement Act (H.R. 4710) is demonstrated by the experience of Radiology Associates of North Texas (RANT), one of the largest independent radiology groups in the US. According to Radiology Business (5/20/2026), "Radiology Associates estimates it has prevailed in about 95% of finalized IDR disputes with Blue Cross Blue Shield of Texas, the state’s largest insurer. However, more than $3.5 million in awarded balances remain unpaid. RANT estimated that $1.64 million of this total has been outstanding for over 120 days. As of Tuesday, BCBS Texas has paid approximately 2% of awarded balances." RANT is not alone in this experience. The Emergency Dept. Practice Management Association (EDPMA), representing well over 60% of the ED groups providing care to ED patients (or organizations supporting the provision of care), released a study in April 2026 of over 659,000 successful NSA IDR claims won by its members in 2025. Yet, 48% of those IDR determinations were not paid within the 30-day period required by law. The total outstanding of award determinations not paid by the health plans exceeded $245,000,000. Congress must pass HR 4710 to give CMS the same enforcement authority it has over hospitals and physicians that it does not currently have over health plans, mainly the ability to assess Civil Monetary Penalties (CMPs) for non-compliance with the NSA. Radiology Associates of North Texas says it will waste over $51M on costs related to No Surprises Act radiologybusiness.com/topics/healthc…

@spartywrx @txsportsdoc ama-assn.org/about/leadersh… Pass the HR 4710 / S 2420 The No Surprises Enforcement Act--requires insurance companies to comply with the NSA and pay awards.

@txsportsdoc Wait even if the doc wins BCBS can just not pay and the 5th circuit says they have no standing to sue? wtf?

The No Surprises Act created an entire new industry and costly bureaucracy for medical claims that should have been paid. The arbitration process costs doctors and groups sometimes more than the claim and you must pay the fee with no guarantee you’ll be paid a penny. Alas this article states, in some instances only 2% of the submitted claims are paid, but the arbitrators are paid regardless. Those listing single “large” payments as the rule, rather than the exception is disingenuous. One single “large” payment may still not even cover all the unpaid claims submitted. now insurance companies are in many cases, ignoring the decision by the arbitrator and not paying the claims. The fifth circuit court of appeals has now prevented physicians from suing to collect these amounts due to them, often siding “standing”.

@spartywrx @txsportsdoc No. The assignment of benefits does not address insurance failure to pay, it only addresses who/where to pay.

@txsportsdoc Doesn’t an assignment of benefits for billing fix this?

@pgipe @txsportsdoc @statnews And then when the insurers lose, they do not pay the awards. Pass the No Surprises Enforcement Act HR 4710 / S 2420 which will force health insurance companies to comply with the NSA. ama-assn.org/about/leadersh…

@txsportsdoc Hang on, but @statnews just told us how physicians are the problem here.

@pgipe @txsportsdoc @statnews Statnews article ignores the fact that 95% of claims that could go to arbitration never do. Of those that do, independent professional arbiters decide in favor of the doctor based on the criteria. Sometimes the insurance company does not respond or only offers $1. #InsuranceFails

Physicians deeply care about their patients. We need Congress to reform Medicare physician pay to safeguard physician practices and patient access to high-quality care. Learn more. bit.ly/3NCjXv9

@EdGainesIII @AnthemBCBS @ElevanceHealth Coercive contracting limits access to care, stifles competition and leads to health care provider consolidation. Oh--and it's illegal. Thanks @CalHospitals for suing to protect patients from @ElevanceHealth.

Excellent news that the CA hospital association has filed a lawsuit against @AnthemBCBS (or whatever they are called this week @ElevanceHealth or "Little Brother" as I like to call them) regarding the plans' policy to penalize hospitals (cutting facility reimbursement) for permitting out of network (OON) physicians to provide care at the hospital. Anthem's policies are illegal on multiple grounds under state and federal law and the hospital association's successful case will be an important precedent.

Thank you Dr. Murphy, fighting for NC hospitals, physicians and patients against @UHC & their latest ploy to squeeze more $ from the aforementioned. At a +2$B run rate of profits (based on their Q1 ‘26 earnings report), UHC will stop at little to raise that run rate even higher and the physician community must fight back.

@ZP_PAC @EdGainesIII @EDPMA @ZotecPartners So deserving. Thanks @EdGainesIII for all of your leadership and mentoring. You truly make a difference for our patients.

Big news 🎉 @EdGainesIII has been awarded the Leadership Award at the @EDPMA #SolutionsSummit, recognizing his outstanding impact across the industry. Well deserved and a proud moment for our team @ZotecPartners #Leadership #Healthcare #Advocacy #EDPMA

Dr. Hilary Fairbrother received @ACEPNation 911 Network Member of the Year award. It is for grassroots advocacy work and her national work on a physician in every ER. #LAC26

The @WaysandMeansGOP Committee held a hearing examining the impact of rising health care costs on patients and families, including how consolidation and for-profit conglomerates are making healthcare unaffordable for the average American. The system needs to see more competition and a national discussion about whether we need ‘for-profit’ entities in healthcare.

@A4Horg @AmerMedicalAssn @EdGainesIII @EDPMA @reh3md @drdanchoi @amychomd @AmerMedicalAssn Thank you for clearly laying the abuses insurers use to undermine the #NoSurprisesAct Doctors want to take care of patients. Insurers want to collect premiums and deceptively avoid paying for #HealthCare

Excellent letter this week from @AmerMedicalAssn & 111 other physician organizations to the Tri-Departments explaining how #health #insurance companies are increasingly undermining the #NoSurprisesAct. searchlf.ama-assn.org/letter/documen… @EdGainesIII @EDPMA @reh3md @drdanchoi @amychomd @DrDiGiorgio @tjsugarman @ZotecPartners @MStempniak @_daniel_payne @kelhoops @misswilson @HeathVeuleman @PaulaMutoMD @MarilynHeineMD #patients #fairIDR #NSA #medtwitter #healthcare

Heading to the Hill with @EmergencyDocs to advocate for#ABC-ED act to fix Emergency Department #Boarding. #Vituity

@sangerkatz @sarahkliff I appreciate that accountability for unintended consequences of the NSA is key. As always, emergency physicians’ top priority is ensuring patients’ access to emergency care. I’d welcome the opportunity to connect and discuss further if you decide to cover this more in the future.

@tjsugarman @sarahkliff Breast reduction surgeries may not be the highest volume category of claim, but it is not trivial in dollar terms. It's also a category of claim--unlike emergency medicine--that lawmakers did not seriously consider when writing the law.

Really misleading article @sarahkliff @sangerkatz . Breast reduction is only 0.014% of all IDR cases. More than 37% are Emergency Medicine because insurers systematically game the system, sometimes trying to pay $0 for an ER case.

Thanks First Lady of Delaware for making the link between taking care of patients and political advocacy. #Vituity #ACEP

The entire Insurance Industry is destroying American healthcare. Their endless and feverish pursuit of profits are pushing Doctors out of medicine and killing patients. Shame on @UHC and @AnthemBCBS for your recent actions. Just a few examples.

nytimes.com/2026/04/25/us/… Another tragic shooting highlighting the dangers of policing. Condolences to the officer's family and CPD. Thankfully, the heroic police prevented any patients and healthcare workers from injury. #HeroicPolice #StopHospitalViolence

#EmergencyDepartmentBoarding puts all of us at risk. theatlantic.com/health/2026/04… Thanks @RosenthalHealth for writing this heartbreaking story. My condolences. @EDPMA @EmergencyDocs

thelundreport.org/content/health… “These are not targeted audits, but rather blanket denials – ignoring the clinical records.” Same problem in every state. Illinois needs to pass SB3114.