For now, legal battles surrounding the No Surprises Act have portions of the Act held up in court. What’s next?
The No Surprises Act (NSA), designed to protect consumers against unanticipated out-of-network medical bills, went into effect the first of this year.
Surprise medical bills are a serious concern for American consumers. Unexpected expenses often occur in emergency scenarios when patients are unable to consent to care. The data indicates patients have a right to be worried. Approximately 1 in 5 emergency claims and 1 in 6 in-network hospitalizations have at least one out-of-network bill amounting to potentially hundreds or thousands of dollars.
Protections from No Surprises Act
The NSA protects consumers through the following provisions:
- Health plans must cover unexpected bills at in-network rates.
- Out-of-network providers of emergency care are prohibited from balance billing.
- Out-of-network providers may not bill patients for excess charges.
A Ruling Is Reached
As required under the NSA, an independent dispute resolution (IDR) mechanism was set up. In October 2021, the Texas Medical Association sued the Biden administration, arguing that portions of the IDR mechanism were inconsistent with the NSA and should be invalidated.
In February 2022, a judge agreed and issued a rule setting aside portions of the rule creating the IDR — specifically, parts of the IDR intended to help keep healthcare costs down. Without those guidelines, providers are better able to use the IDR process to charge higher out-of-network payments.
Federal officials are set to deliver final IDR guidance in May. While the current NSA continues to protect consumers, similar legal challenges could erode the law over time.
For updates on the NSA, visit cms.gov/nosurprises.