No Surprises Act prevented 10 million surprise bills in 2023, survey finds

Photo: Jose Luis Pelaez/Getty Images

During the first nine months of 2023, the No Surprises Act (NSA) protected Americans from more than 10 million surprise medical bills, according to a new survey by AHIP and the Blue Cross Blue Shield Association.

The NSA prevented more than 10 million surprise medical bills from healthcare facilities, providers and air ambulance providers from reaching patients, the survey showed. Another key finding: 67% of health insurance providers indicated they increased their provider networks since the enactment of the NSA, with no plans reporting decreases in provider networks.

Overall, the majority of health insurance and healthcare providers say the NSA is working. For almost 80% of NSA-eligible claims resolved without the use of the Independent Dispute Resolution (IDR) process – a negotiating process intended for use in limited circumstances – providers accepted the initial payment offered by health insurance providers.

WHAT'S THE IMPACT?

AHIP and BCBSA fielded the survey nationwide in November 2023 to a diverse group of health insurance providers (commercial market, self-funded group health, fully-insured group health plans and individual market coverage). It was distributed to 80 health insurance providers. Twenty-one health insurance providers, representing 65% of the total commercial market, responded to the survey via an online tool.

The research did find a growing and troubling trend: the skyrocketing use of IDR.

Before the law took effect, federal agencies estimated that 17,000 claims would go through the IDR process annually. In fact, between April 15, 2022, and March 31, 2023, 334,828 disputes were initiated through the IDR portal, nearly fourteen times greater than the initial estimate.

Authors claimed this increase in the use of the IDR process suggests that certain providers and hospitals may be attempting to exploit the arbitration process solely to increase profits. A single dispute, as reported by CMS, could represent a batched dispute of many claims or a group of several claims for a single visit. The Certified IDR Entities must review each claim individually, meaning the volume of claims is even higher than the number of individual disputes, increasing the burden on IDR entities and driving health care costs higher through associated fees. Healthcare costs are likely to increase unnecessarily if this trend continues.

Still, the overall assessment of the NSA remained mostly positive.

"Getting a bill is never fun," said David Merritt, senior vice president of policy and advocacy for BCBSA. "Getting a surprise bill is awful. I'm proud to see that the No Surprises Act is doing what it's supposed to – protecting millions of families from unexpected financial hits and the peace of mind that a surprise medical bill won't cost them their next paycheck."

THE LARGER TREND

The No Surprises Act was signed into law on December 27, 2020. Most of the law's provisions took effect at the beginning of 2022, applying to those enrolled in commercial health insurance coverage or group health plans renewing on or after January 1, 2022. Under the law, when anyone covered by private health insurance is treated for emergency services or at an in-network facility by an out-of-network provider, the healthcare provider or facility, such as a hospital, is prohibited from billing a patient above their in-network cost-sharing amount.

In December 2021, the American Hospital Association, American Medical Association and others sued the Department of Health and Human Services and the other federal agencies over implementation of the NSA.

The groups were not against the legislation, they said in the lawsuit, but took issue with how HHS implemented the IDR process to resolve payment rates between provider and payer. The interim final rule stipulated that the arbitrator must select the offer closest to the Qualifying Payment Amount, which is set by the insurer.

Later that year, the U.S. departments of Labor, Health and Human Services, and Treasury issued final rules to clarify the arbitration process.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.