Dispute Process in No Surprises Act Must Remain Between Doctors and Insurers
By Consumers for Quality Care, on July 17, 2024
The No Surprises Act has helped many consumers avoid unexpected medical bills that arise from an emergency procedure performed out-of-network. While some contend that continued disputes between insurers and providers over who should pay for what could lead to higher insurance premiums for all consumers, according to ProPublica, the process remains an important tool in ensuring consumers aren’t caught between providers and insurers in surprise billing situations.
The No Surprises Act protects patients from surprise medical bills. These bills arise most often when a patient is treated by an out-of-network medical provider without the patient’s knowing that the provider was outside their insurance network. The law eliminated many surprise medical bills by requiring insurers to cover these out-of-network claims and by prohibiting providers from charging out-of-network patients more than they would be charged if they were in-network.
The law also created an arbitration system designed to keep patients out of disputes between providers and insurance companies in these situations. Unfortunately, the billing arbitration system established in the law has been met with numerous court challenges and has been the subject of congressional committee hearings. Insurers and providers are each alleging that the other side is abusing and manipulating the system, trying to extract as much revenue as possible. Dr. Andrea Brault, who runs the Emergency Department Practice Management Association, calls the arbitration system in the law “a costly, lengthy process,” while Kelly Parsons with the Blue Cross Blue Shield Association warns that “should this trend continue, health care costs are likely to rise unnecessarily.”
The number of disputes submitted underscores the need for the law in the first place. When the law was passed, the federal government projected that about 17,000 dispute cases would be filed. In 2023, 680,000 cases were filed. This has created an enormous backlog, where half of all filed cases remain unresolved. Court cases challenging the arbitration process forced the government to adjust its guidelines to the process, but these challenges have also created more delays.
This law must continue to meet its original intent, to save consumers from surprise billing.
Consumers shouldn’t have to pay higher premiums just because insurers and providers are no longer able to issue surprise bills. CQC believes that consumers should be kept out of the middle of these fights between insurers and providers.
