Who Is Actually on the Other Side of a Federal Dispute

A fully insured plan is one an insurance company sells and bears the risk on. A self-funded plan is one an employer pays claims out of its own money, usually hiring a carrier only to administer it. The name on the card can be identical in both cases — which is exactly why this trips people up.

It matters because ERISA preempts state insurance regulation of self-funded employer plans. A state surprise-billing law, however good, generally cannot reach them. So for a self-funded plan the federal IDR process is the route, even in a state that runs its own arbitration system.

The scale of this is visible in the table above. UnitedHealthcare was the most frequently disputed party in the second half of 2024 with 242,711 disputes, and 74% of them involved self-funded or partly self-funded plans. Across all disputes in the fourth quarter of 2024, CMS recorded 320,845 of 478,849 initiations against self-funded or partly self-funded plans.

Where to find it

• The plan document or summary plan description states it directly — look for a stop-loss or self-insurance reference.
• An employer plan administered by a carrier but paid by the employer is self-funded, whatever the card says.
• If the answer is genuinely unclear, the federal route is usually the safer filing — but the deadline runs either way, so the question needs answering early rather than accurately-but-late.

The last column of the table is worth a second look as well. “No issuer response” counts disputes where the plan type was never established because the issuer did not respond. 93,407 disputes among these parties alone fell into that category in the second half of 2024.