AHIP And BCBSA Analysis Finds New Law Prevented More Than 2M Surprise Medical Bills

More than 2 million potential surprise medical bills across all patients in commercial plans were prevented in the first two months a key law went into effect, a new study said.

Insurance groups AHIP and the Blue Cross Blue Shield Association released a survey and analysis (PDF) of the impact of the No Surprises Act, which banned surprise medical bills starting this year. The analysis comes as providers and the Biden administration continue to battle in court over how to handle disputes over surprise bills.

“As recently as last year, an emergency visit to the hospital may have left patients on the hook for steep, surprise medical bills,” said Kim Keck, president and CEO of the Blue Cross Blue Shield Association, in a statement. “The No Surprises Act has not only put an end to this loophole, but it has provided undeniable financial protection to millions of Americans.”

AHIP and the Blue Cross Blue Shield Association surveyed insurance plans that offer commercial coverage to get information on the number of claims that would be eligible for dispute under the No Surprises Act in January and February of this year. Overall, 31 plans that represent 54% of the total commercial market responded with the total claims and the number eligible for dispute.

If the current pace of claims holds, more than 12 million surprise medical bills would be avoided this year due to the law, the analysis said.

It remains unclear how many of the 2 million would be disputed under the law’s arbitration process, which calls for the payer and provider to seek out a third party if they can’t reach an agreement within 30 days on an out-of-network charge.

“If only a fraction of these claims are ultimately disputed through [independent dispute resolution], it would still far exceed the government’s estimate,” the analysis said.

The survey comes as a legal dispute between providers and the Biden administration continues to make its way through the federal court system.

Under the law, providers and payers would enter an arbitration process if they cannot resolve the amount for an out-of-network charge. Both parties would pick their own amount, and a third-party arbiter would choose one.

However, a rule issued last year by the Department of Health and Human Services (HHS) on how the arbiter should pick an amount drew the ire of providers. The rule said that the arbiter should pick the number closest to the qualifying payment amount, which is based on the geographic rate for the out-of-network charge.

Providers charged that the rule directly contradicts Congress’ intent when it created the law, arguing that a benchmark rate was specifically not included. Payer groups, on the other hand, have cheered the arbitration rule.

A federal judge recently vacated key parts of the rule, handing providers a massive win, but HHS will appeal the decision.


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