It's been 100 days since the No Surprises Act went into effect, but America's Health Insurance Plans says additional regulations are still needed.
The No Surprises Act protects people covered under group and individual health plans from receiving surprise bills after most emergency services, nonemergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance providers, according to an April 7 AHIP brief.
To determine out-of-network reimbursement rates, the No Surprises Act created an independent arbitration process to provide dispute resolution opportunities for uninsured and self-pay individuals who have received a surprise bill.
Interim final rules from October 2021 direct arbitrators to go with the rate closest to the qualifying payment amount, but they can consider information submitted by payers and providers about why they should not choose the amount closest to the qualifying payment amount.
The interim rules have drawn fierce legal opposition from medical groups, who claim the arbitration is an "illegal interpretation" by the federal government. A federal judge in Texas also struck down the arbitration provision in February.
New final rules on the arbitration process are expected this summer.
Issues that still need addressed, according to AHIP:
- Ground ambulances remain unregulated by federal law and are often the reason for surprise billing.
- Increasing consolidation between providers and hospitals must be addressed to promote market competition, avoid market failures and reduce care costs.
- The lack of incentive for some providers to participate in health plan networks needs to be addressed in the new law so consumers have more access to high-quality providers without risk of a surprise bill.