The Problem

Surprise medical billing – also known as “balance billing” – made it harder for patients to afford necessary medical care, and even bankrupted families, often when they least expected it. 

Analysis demonstrated that some out-of-network providers and specialists created lucrative business models centered on sending surprise medical bills to patients. Charges billed by out-of-network providers far exceeded average negotiated rates – often by three or four times the negotiated price in the same market. By sending surprise medical bills, certain physicians were adding $40 billion in unnecessary costs to the health care system. 

Unfortunately, 16 lawsuits have been filed challenging the law, implementing regulations, and IDR decision process. 

■ These lawsuits, often driven by private-equity backed providers, threaten to restrict and do away with the protections put in place by the NSA. 

■ Recent polling has shown that a bipartisan majority of voters are concerned these lawsuits could delay or overturn the patient protections in the No Surprises Act (73%) and increase health care costs for patients (78%).

Not only are providers challenging the No Surprises Act in the courts, but they are also working to overwhelm the dispute arbitration system – resulting in increased time and money spent handling claims. 

■ The Centers for Medicare and Medicaid Services received over 90,000 claims in just five and a half months, far exceeding expectations.

■ With 69% of closed disputes found to be ineligible, it’s clear that some providers are putting their profits ahead of patient needs.