Thousands of Consumer Complaints Allege Noncompliance with No Surprises Act 

By Consumers for Quality Care, on September 11, 2024

More than 12,000 consumers have accused insurers and providers of not complying with the No Surprises Act, according to data from the Centers for Medicare & Medicaid Services (CMS), Healthcare Dive reports.  

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 barring providers from charging out-of-network patients more than their in-network prices.  

The law also created an arbitration system, so that providers and insurers can resolve disputes without forcing the consumer to get involved. Unfortunately, insurers have challenged this arbitration system in court, and CMS’s rules about how the system should work have been the subject of several congressional hearings. Insurers and providers each allege that the other is abusing and manipulating the system, trying to extract as much revenue as possible. As a result, consumers have been caught in the middle of these billing disputes. 

Though most complaints stem from consumers’ receiving unwarranted surprise bills, the law has prevented millions of surprises bills being sent to consumers.  

This law must continue to meet its original intent, to save consumers from surprise billing. CQC urges regulators and lawmakers to continue monitoring the implementation of the law, ensuring all patients are always protected from surprise medical bills.