Surprise bills can be expensive, and usually occur when a patient unknowingly receives care from an out-of-network provider, even if they’re at an in-network facility.

Thankfully, bipartisan members of Congress passed the No Surprises Act in 2020 to tamp down on this practice by removing consumers from the surprise billing equation and putting affordability and patient needs first.

Unfortunately, continued legal challenges filed against the No Surprises Act threaten the protections meant to help patients by challenging the law, implementing regulations, and IDR decision process.

Here’s where things stand on the No Surprises Act:

  • In the first 9 months of 2022, 9 million surprise bills were prevented.
  • In December, the federal government reported receiving over 90,000 requests for arbitration between April 15 and Sept. 30.
    • Of the disputes that were closed, 16,000 (69%) were found ineligible for the IDR process.
  • While this is many more claims than the Administration expected, these numbers demonstrate the No Surprises Act is working over 99% of the time.
  • Sadly, some providers don’t view this as a success. They want to protect their right to send surprise bills to patients. Worse, earlier this year, the Texas Medical Association filed its fourth lawsuit challenging portions of the final rule implementing the No Surprises Act.
  • There are now 16 lawsuits filed against the No Surprises Act, implementing regulations, and decisions by IDR entities.

These legal challenges could remove patient protections and cost saving measures which have already prevented 9 million surprise bills from reaching patients. As certain providers seek to change the arbitration process, some are abusing the system to push for the outcomes they want, likely resulting in higher costs for patients.

While legal challenges continue to target the patient protections in the No Surprises Act, the Administration must stand firm in their work to implement the law and protect patients from unfair surprise medical bills while also lowering health care costs.