Congress passed the No Surprises Act (NSA) with strong bipartisan support to protect patients from surprise medical bills. Even now, with the NSA protecting patients from millions of medical bills, certain providers continue to undermine the process and weaken the regulations. Here’s what you need to know as we head into 2023:
- 9 million in 9 months: According to AHIP and BCBSA data, the NSA protected Americans from 9 million surprise medical bills in the first 9 months of its implementation – averaging about 1 million surprise medical bills a month.
- 73% of voters: A recent poll conducted by Morning Consult on behalf of the Coalition Against Surprise Medical Billing found that a strong majority of voters (73%) are concerned that lawsuits from some physician and hospital organizations could delay or overturn the patient protections in the No Surprises Act – including a majority of Democrat, Republican, and independent voters with employer-provided coverage.
- 90,000 claims filed: Despite the Centers for Medicare and Medicaid Services (CMS) expecting fewer than 18,000 IDR claims to be filed this year, some 90,000 claims have been filed in just five and a half months, far exceeding CMS estimates.
- 41,000 disputes challenged: During that window, non-initiating parties challenged the eligibility of over 41,000 disputes – time and money spent wrapped in red tape rather than focusing resources on patient care.
- 22,000 disputes ineligible: As a result of certain providers intentionally overwhelming the system, certified IDR entities have found over 22,000 disputes ineligible for the IDR process – roughly one quarter of all disputes filed, which evidences the providers’ strategy to overwhelm the IDR process.
- 40% to 82% increase in fees: In addition to the explosion in arbitration claims, the upper limits on the fees certified IDR may charge is increasing for 2023. Beginning next year, certified IDR entities are permitted to charge a fixed fee for single determinations that could increase by as much as 40%. For batched determinations with 81 line items or more, fees could rise by 82%.
- 59 organizations: Just last week, nearly 60 organizations highlighted concerns with these troubling statistics: Organizations representing patients, consumers, unions, and employers recently wrote to the tri-agencies:
“Employers, unions, and health plans have struggled to keep up with the myriad disputes, sometimes thousands of claims at once, to which they must respond – this adds a significant, time-consuming burden and takes time and resources away from providing high-value health benefits to enrollees.”
Unfortunately, as certain providers and private equity-backed groups continue to abuse and overload the IDR system, patients will pay the price in the form of higher costs.
Visit our website for more information and why it is more important than ever that the Administration stay the course in implementing the No Surprises Act.