In light of a final rule issued by the Biden Administration regarding surprise medical billing, the Coalition Against Surprise Medical Billing sent a letter this week to the tri-agencies emphasizing the need to protect patients and their families when it comes to the arbitration process for handling surprise medical bills. The Coalition emphasized that the work to protect Americans from harmful provider billing practices is far from over, especially as some providers and hospitals may seek to abuse the independent dispute resolution process (IDR).

In the letter, the Coalition highlighted the success of the No Surprises Act, which this year is already on track to prevent 12 million claims from becoming surprise bills. While the success of the law is remarkable, the increase in use of the IDR process could suggest a concerning trend of certain providers and hospitals, likely those backed by private equity firms, attempting to exploit the arbitration process to increase their profits. As the final rule is implemented, the Coalition called on the agencies to ensure arbitration is used sparingly so the No Surprises Act can continue to do what it was designed to do – lower health care costs and permanently protect patients from surprise out-of-network bills.

Highlights from the letter include:

  • “Our priorities have included prohibiting out-of-network providers from sending surprise bills to patients, maintaining fair and market-based payments for out-of-network care, and reducing consumers’ health insurance premiums and taxpayer costs by avoiding an arbitration process that adds unnecessary expense, delay, and bureaucracy to the health care system.”
  • “While the law’s success at preventing surprise billing is remarkable, another troubling trend has emerged. A status update from the Departments on August 19th also demonstrated how providers and hospitals have been using the independent dispute resolution (IDR) process significantly more than originally anticipated, with 46,000 disputes initiated in just under four months.”
  • “As payers of health care for most Americans, the Coalition is concerned that private equity firms are continuing to take advantage of market and regulatory uncertainty, using their vast resources to exploit working families for short-term profit.”
  • “As the new rule is implemented, we strongly urge the Departments to consider approaches that make it clear to all parties that IDR is meant to be used sparingly as a backstop in unique cases where the plan and provider cannot reach an agreement on what constitutes a fair reimbursement. Arbitration is not meant to be used for every out-of-network claim, or even the majority of such claims.”
  • “CASMB and our members remain steadfast in our in our commitment to seeing this law implemented fully, fairly, and in a non-inflationary manner.”
  • “The American people are concerned about those lawsuits impacting the No Surprises Act, with 79% of voters – a bipartisan majority – expressing concern that lawsuits from physician and hospital organizations could delay or overturn the No Surprises Act. Many of the same physician and hospital organizations that have sued to halt implementation also appear to be engaging in efforts to overwhelm and abuse the IDR process to their financial advantage.”

To view the full letter, click here.