The American Medical Association, alongside more than 100 other specialty societies and state medical associations, wrote an open letter to federal officials cautioning them against health plans undermining the federal No Surprises Act April 27.
The letter acknowledges the complexity of the NSA’s implementation, but emphasized several ways it claims insurers are “circumventing the statute with harmful policies that shift costs onto patients and undercut independent physician practices.”
The letter was addressed to the departments of treasury, labor and HHS, which hold oversight roles of the NSA. The letter urged the departments to use their enforcement authority to deter several practices and language that go against the intention of the law.
The AMA specifically cited several practices, including:
- Inappropriate cost-shifting onto patients: The AMA said that payers are reportedly increasing patient cost-sharing amounts after an independent dispute resolution decision in favor of the physician.
- Misuse of technical guidance to re-open closed IDR cases. Some payers allegedly began exploiting June 2025 technical guidance intended to allow IDR cases to be reopened in a narrow set of circumstances in a way that results in withheld payment.
- Ineligible IDR claims. The AMA argues that eligibility can be a challenging determination for physicians, including determining the appropriate regulatory. The letter claims that payers possess plan information that makes them best suited to identify eligibility for the process, but withhold this information from physicians.
- Lack of transparency into qualified payment amount calculations. Physicians have reported that QPA calculations do not reflect market rates for services, creating a need for further transparency.
- Delayed or incomplete payments. Payers are “failing to reconcile payment outside of the statutory 30-day window,” according to the letter, or are paying only a portion of what they owe.
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