No Surprises Act Dispute Process Reopens After Flawed Implementation 

By Consumers for Quality Care, on January 10, 2024

The dispute resolution portal created by the No Surprises Act was designed to keep consumers out of payment disputes between providers and insurance companies. After being shut down earlier this year because of backlogs and delays, the portal, according to Healthcare Dive, is now fully reopened.

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 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, congressional hearings, and bureaucratic hurdles. Throughout all this, policymakers have been looking to improve the dispute-resolution process.

According to regulators, there have been more arbitration cases than originally expected. The significantly large number of additional claims created backlogs and delays, and the claim-submission portal was shut down as a result. Its reopening may be attributed, in part, to changes proposed by the Biden administration. These changes are meant to require more negotiation between payers and providers.

Additionally, last Fall, the U.S. House Ways and Means Committee held a hearing to question the implementation of the independent dispute resolution (IDR) process. Members argued that the IDR process was favoring payers and undermining the congressional intent of the law meant to protect consumers.

Caught in the middle of these disputes are patients and consumers, who simply need their medical bills covered. The No Surprises Act has proven effective at insulating them from disputes between insurers and medical providers. Whatever the future may hold for this process, policymakers must ensure that consumers are not once again on the hook for surprise bills.