Insurers say No Surprises Act helps millions, hospitals say aspects remain flawed

Groups representing doctors and hospitals say they support the spirit of the law, but a process to resolve billing disputes is tilted in favor of insurers.

Insurers contend the No Surprises Act is living up to its billing by keeping consumers from being shocked by costly and unexpected medical bills.

Meanwhile, hospitals and doctors say key provisions of the law are unfairly benefitting insurers, and are hurting providers.

The No Surprises Act took effect at the beginning of the year and is designed to protect patients from receiving unexpected bills for out-of-network care.

The law has prevented more than nine million unexpected medical bills from reaching consumers this year, according to a report by AHIP and the Blue Cross Blue Shield Association released earlier this month.

Matt Eyles, AHIP president and CEO, said the report suggests the No Surprises Act is helping consumers in the way lawmakers envisioned.

“Thanks to the No Surprises Act, millions of Americans no longer face a complicated, confusing billing bureaucracy, being harassed by collection agencies, or even potential legal action,” Matt Eyles, AHIP president and CEO, said in a statement.

“The No Surprises Act has provided relief from the fear, stress, and frustration that comes with surprise medical bills, and we’ll continue to work with the Administration, Congress, and other health care stakeholders to protect patients from surprise medical bills for care they did not choose—or they didn’t even know they received in the first place,” he said.

David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association, said the law is succeeding in protecting patients.

“A health care emergency should not lead to a financial crisis. The No Surprises Act has now protected 9 million Americans from receiving costly surprise medical bills from care providers—a huge win for patients,” Merritt said in a statement.

Hospitals and physicians have said they support the spirit of the law in protecting consumers from unexpected bills. But they have repeatedly said the process to resolve billing disputes is problematic.

Hospitals, physicians and healthcare organizations say they remain concerned that the arbitration process is unfairly titled in favor of payers.

The Texas Medical Association has filed a lawsuit claiming the dispute resolution process gives commercial insurers an unfair advantage. The American Hospital Association and the American Medical Association have filed a brief in court in support of the Texas Medical Association suit.

Members of Congress have expressed concerns about the arbitration process, and those concerns cross party lines.

U.S. Rep. Richard Neal, D-Mass., and Kevin Brady, R-Texas, have written a letter Nov. 18 to key members of the Biden administration expressing concerns over some facets of the legislation. Neal is the chairman of the House Ways and Means Committee and Brady is the ranking Republican.

The lawmakers noted that a federal court ruling found the dispute resolution process was flawed, but the administration’s revisions don’t solve the problem. "We are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before," the lawmakers wrote.

In November 2021, a bipartisan group of 152 members of Congress wrote a letter outlining their problems with the arbitration process.

In the insurers’ report touting the success of the No Surprises Act, they also note that providers have submitted 275,000 claims to be resolved by arbitrators. The insurers said that’s 10 times as many claims as anticipated by the Biden administration.

Merritt said the high number of arbitration claims “clearly demonstrate that more needs to be done to ensure that they don’t abuse the system for their financial gain.”

Still, physicians and medical groups continue to challenge the arbitration process, and they are also troubled by some of the administrative hassles involved in the No Surprises Act.

The Medical Group Management Association said the demands of the No Surprises Act are adding to the administrative burdens practices are facing.

Roughly four out five groups (82%) said they have seen greater administrative burdens from  requirements to provide good faith estimates for those without insurance or patients who are paying out of their own pocket, according to an MGMA survey. Nearly three quarters (74%) of participants said they don’t have the infrastructure to comply with new requirements that are taking effect next year.