6 things to know about the 1st year of the No Surprises Act

The No Surprises Act, which protects consumers from out-of-network charges for emergency care and other services, took effect Jan. 1 of this year. 

While data shows the new policy is saving patients money, questions and lawsuits over how disputes about bills will be resolved between payers and providers abound. 

Here are six developments Becker's has reported in the act's first year in effect. 

1. Payers say the act has saved consumers money 

A report from AHIP and the Blue Cross Blue Shield Association found the bill has saved 9 million patients from surprise medical bills since January. A separate study found the act could result in 3 million more emergency room visits each year, because individuals no longer fear catastrophic bills. 

2. CMS issued a final rule on how disputes between payers and providers over out-of-network rates will be solved in August 

In November, the House Ways and Means Committee called the rule "seriously disappointing." Critics have argued the rule gives too much power to payers. 

3. Disputes have centered on the arbitration process

The Texas Medical Association filed its third lawsuit challenging the act on November 30.  In a news release, the association said it was challenging rules that "skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic."

The Texas Medical Association filed its first No Surprises Act lawsuit in October 2021, successfully arguing that requiring arbitrators to heavily weigh figures created by insurers conflicted with the law and provided insurers with an unfair advantage unintended by Congress. 

The group filed a second lawsuit in September, arguing the final rule "unfairly advantage[s] health insurers by requiring arbitrators to give outsized weight or consideration to the [qualifying payment amount]." A hearing in that case is scheduled for Dec. 20. 

4. Many provider organizations have backed the Texas Medical Association's challenges

In October, the American Hospital Association and the American Medical Association, along with 30 additional national and state medical groups, filed amicus briefs supporting the Texas Medical Association's second lawsuit. 

5. Payers have backed HHS' rule

AHIP filed an amicus brief Nov. 16 in Texas Medical Association v. HHS. The association says the arbitration rule does not give payers the upper hand. In a press release, the trade association said there is "no basis" to providers' claims the arbitration rates will cause payers to lower reimbursement rates and narrow networks. 

6. There is a lengthy backlog of claims

HHS has received more than 90,000 claims since launching the independent dispute resolution portal in April.

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