We were disappointed when ClaimMD raised their rates, but they are still for us, hands down the best clearinghouse we've used. Our fees went up 800% but we are sticking with them. Years ago, insurance carriers used to pay the clearinghouses to receive the claims electronically. Now everyone is submitting electronically so it's no longer necessary. The clearinghouses have to make up for that loss of revenue. Compared to other clearinghouses, they are still cost effective.