No Surprises Act Shielded Patients From 10M Surprise Bills

Patients were protected from more than 10 million surprise medical bills thanks to reforms in the No Surprises Act, according to a new survey.

The analysis, backed AHIP and the Blue Cross Blue Shield Association, found that nearly 80% of claims disputed under the law were resolved before reaching the independent dispute resolution (IDR) stage, a process that has drawn ire—and legal challenges—from providers.

In addition, the survey found that 67% of the 21 insurers surveyed said they have grown their provider networks since the act has taken effect, and none have narrowed their networks. The surveyed payers represent 139 million covered lives in the commercial market, or about 65% of that sector.

Adam Beck, senior vice president of commercial product and employer policy at AHIP, told Fierce Healthcare that this is the third time the organizations have conducted this survey, and all three point to the same idea: Patients benefit from the No Surprises Act’s changes.

“I think what each of them has underscored is that the No Surprises Act is working really well for patients,” he said. “And it’s impacting millions of patients and millions of consumers every year, whether they realize it or not.”

While the insurer survey noted the positive changes for patients, AHIP said it does also raise a “growing and troubling trend” with the number of disputes headed to IDR far outpacing federal estimates.

Before the No Surprises Act’s reforms rolled out, federal agencies projected that about 17,000 claims each year would reach the IDR phase. However, between April 2022 and March 2023, there were 334,828 initiated IDR disputes, which AHIP said is nearly 14 times the estimate from the Centers for Medicare & Medicaid Services (CMS).

The insurance industry groups said this may signal that some providers and hospitals “may be attempting to exploit the arbitration process solely to increase profits.”

The IDR process has proven controversial for providers. The Texas Medical Association, for example, has extensively challenged the model in federal courts, leading CMS to pause IDR processing multiple times.

The approach to IDR has evolved over time as more feedback has come in about how it’s working from both payers and providers. Further changes are in the works, and AHIP supports those that improve the experience for all parties, said Marcy Buckner, vice president of employer health policy and advocacy at AHIP, in an interview with Fierce.

“A lot of those improvements will be able to enhance communication between the parties during the IDR process,” she said, “which we know has been a huge barrier to being able to resolve the claims through open negotiation before actually getting to an [independent dispute resolution entity] or getting a final determination.”

Buckner said the number of disputes resolved before reaching IDR means the overall process is working, “it’s just really clunky.”

Beck added that the fact that so most bills are resolved in negotiation means the general payment guidelines work for most providers, though legal challenges have called qualifying payment amounts into question. The volume of providers accepting these payout suggest that QPAs are, broadly, a fair market value, he said.

Plus, the number of payers that said they’ve expanded their networks under the No Surprises Act is also a sign the reforms are functioning as intended, he said, and it’s a trend AHIP would like to see continue.

“Hopefully, the totality of this process will lead more providers to be inclined to participate in health plan networks and not have to worry about any of this at all,” Beck said.


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