Anthem has not paid 74% of the No Surprises Act arbitration awards it lost since 2024, the highest nonpayment rate among major insurers, The New York Times reported Nov. 3.
The figure comes from medical billing firm HaloMD’s data on 409,102 independent dispute resolution cases from January 2024 to July 2026, which the Times reviewed. Across all insurers, 29% of awards went unpaid. Cigna left 53% unpaid, UnitedHealthcare and Aetna 24% each, and Health Care Service Corp. 12%.
The law requires insurers to pay arbitration awards within 30 days. Anthem, a subsidiary of Indianapolis-based Elevance Health, estimated in a 13-page report that 60% of the cases arbitrators decided should never have qualified for the process. Its nonpayment rate climbed to 83% in 2026, according to the HaloMD data.
“More providers are submitting ineligible cases because ineligible cases aren’t being dismissed like they should be,” said Ariel Bayewitz, vice president of health economics at Elevance.
Providers say unpaid balances are straining operations. Air ambulance company PHI closed a base in Red Bluff, Calif., which CEO Scott McCarty attributed to $16.3 million in outstanding Anthem payments. Wake Emergency Physicians in North Carolina took out a line of credit in January to make payroll while carrying $1.2 million in unpaid awards.
Enforcement options remain thin. Three federal appeals courts have ruled that providers cannot sue to enforce awards, and federal regulators have not issued a single $100-per-day penalty for nonpayment. The Labor Department is investigating Anthem’s nonpayment, and an Anthem spokesperson said the insurer is cooperating.
In Congress, Rep. Greg Murphy, MD, R-N.C., has introduced legislation to stiffen nonpayment penalties, while Rep. Frank Pallone Jr., D-N.J., has proposed replacing arbitration with a flat payment set at typical insurer rates.
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