Mon. Oct 3rd, 2022

The No Surprises Act shielded private health insurance enrollees from an estimated 2 million surprise bills during the first two months of the year, according to a report health insurance industry groups released Tuesday.

AHIP and the Blue Cross Blue Shield Association surveyed more than 80 commercial health insurance companies, 31 of which responded. Those insurers represent 115 million commercial health plan members.

These companies reported receiving 600,000 claims covered by the surprise billing law in January and February. Based on claims experiences from prior years and factoring in processing delays this year, the insurance groups estimate that the true amount of such bills at 2 million.

AHIP and the Blue Cross Blue Shield Association project the new rules could prevent more than 12 million surprise bills this year.

Before President Donald Trump enacted the No Surprises Act in 2020, two-thirds of adults reported feeling worried about whether they could afford surprise medical bills, according to a Kaiser Family Foundation survey.

The law, which took effect Jan. 1, aims to protects patients from unforeseen medical bills, including those issued by out-of-network health professionals working at in-network facilities. Regulations implementing the statute require independent dispute resolutions to resolve billing disputes between insurers and providers without patients needing to be involved.

Payers and providers have battled over the particulars of that process as each side seeks to defend its financial interests.

“The law is working to protect millions of consumers from costly surprise bills and yet several hospital and provider organizations have filed lawsuits challenging the [No Surprises Act] regulations and legislation in order to increase their own profits at patients’ expense,” the insurance groups’ report says.

In February, a federal judge ruled that the independent dispute resolution process gives insurers an unfair advantage over providers when determining the final payment amounts. Providers want more negotiating power in deciding their pay.

“This new approach that’s in the law is giving patients certainty,” said Chip Kahn, president and CEO of the Federation of American Hospitals. But the current method for determining how to reimburse providers can lead to underpayments, he said. “Hospitals and clinicians will be shortchanged by insurers who are hiding behind the regulation to basically underpay for services,” he said.

In April, the Centers for Medicare and Medicaid Services revised its guidance on what arbiters can consider when determining appropriate payments. In addition to median contracted rates for services, providers and insurers can submit information about providers’ level of training, providers’ regional market share, patients’ acuity and other relevant factors, CMS advised.



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