Here is a timeline of the No Surprises Act and the challenges it faced since it was signed into law:
Dec. 31, 2020: The No Surprises Act is signed into law. The rules are set to take effect in January 2022.
April 23, 2021: Politico reports that health systems, insurers, trade associations, ambulance companies and physician staffing firms have increased lobbying efforts to determine how the U.S. will enforce its ban on surprise medical billing.
July 2, 2021: CMS unveils the No Surprises Act’s interim final rule. The rule details how payments from health plans to providers will be determined. It appears to keep payment rates lower than those lobbied for by hospitals and other healthcare providers.
Oct. 28, 2021: The Texas Medical Association sues over what it says is an unfair process to resolve billing disputes between health insurers and providers. It is one of several organizations to file lawsuits challenging the rule.
Jan. 1, 2022: The No Surprises Act takes effect.
Feb. 23, 2022: A federal judge in Texas rules that the No Surprises Act arbitration process implemented by HHS violated the Administrative Procedure Act, delivering a win to the Texas Medical Association. U.S. District Judge Jeremy Kernodle says the rule “places its thumb on the scale” for the qualifying payment amount.
March 2, 2022: HHS says it will revise its guidance on the arbitration process outlined under the No Surprises Act following the federal court ruling.
April 22, 2022: HHS files a notice of appeal regarding the Texas federal judge’s ruling in the Texas Medical Association case.
May 3, 2022: HHS requests a hold on its appeal, which is granted.
Aug. 19. 2022: HHS and the Labor Department issue final rules for the No Surprises Act.
Sept. 20, 2022: The American Hospital Association and American Medical Association announce they are dismissing a lawsuit they filed challenging the No Surprises Act, but say they remain concerned that the final rule “continues to favor insurers and does not line up with what Congress intended when it passed the law.”
Sept. 22, 2022: The Texas Medical Association files a second lawsuit challenging the No Surprises Act, arguing the final rule will “unfairly advantage health insurers by requiring arbitrators to give outsized weight or consideration to the [qualifying payment amount].”
Oct. 19, 2022: The AHA and the AMA, along with 30 additional national and state medical groups, file amicus briefs in support of the Texas Medical Association’s second lawsuit.
Nov. 28, 2022: The Texas Medical Association’s lawsuit challenging the validity of the No Surprises Act’s independent dispute resolution could increase an already lengthy backlog, Bloomberg Law reports. HHS launched the IDR portal in April and received more than 90,000 claims in the first five and a half months, substantially more than the department initially estimated would be submitted for a full year.
Nov. 30, 2022: The Texas Medical Association files its third lawsuit against the No Surprises Act, arguing that portions of the rule “artificially deflate the qualifying payment amount.”
Jan. 31, 2023: The Texas Medical Association files a fourth lawsuit, this time challenging a 600% hike in administrative fees when seeking dispute resolutions.
Feb. 6, 2023: Mr. Kernodle rules in favor of the Texas Medical Association in its second lawsuit. He rules that the revised arbitration process “continues to place a thumb on the scale” in favor of insurers and “that the challenged portions of the final rule are unlawful and must be set aside.”
Feb. 10, 2023: CMS instructs certified IDR entities to hold all payment determinations under the No Surprises Act until HHS and the Treasury Department issue further guidance.
Feb. 27, 2023: CMS says certified IDR entities can resume issuing No Surprises Act payment determinations involving out-of-network services and items furnished before Oct. 25, 2022.
March 16, 2023: Representatives for both providers and payers say IDR arbitrators are often not following the No Surprises Act, Bloomberg Law reports.
April 18, 2023: A report from the Urban Institute and the Georgetown University’s Center on Health Insurance Reforms finds that the No Surprises Act is largely protecting patients from the most pervasive forms of surprise billing, but the gaps that do remain have left some with unexpected financial liabilities.
Aug. 3, 2023: Mr. Kernodle rules in favor of the Texas Medical Association in its fourth lawsuit. He found that federal agencies did not follow notice and comment requirements when hiking administrative fees. He also invalidated certain rules narrowing batching claims for arbitration. HHS said it was temporarily suspending the IDR process — including the ability to initiate new disputes — until the federal agencies can provide additional instructions.
Aug. 11, 2023: CMS lowers the IDR fee to $50 following the government’s latest court loss.
Aug. 25, 2023: From Aug. 25 to Sept. 21, CMS temporarily suspended all federal IDR processes in response to a Texas judge’s latest ruling in a series of lawsuits challenging provisions of the No Surprises Act.
Sept. 19, 2023: Missouri Rep. Jason Smith, chairman of the House Ways and Means Committee, held a hearing alleging that the federal government’s flawed implementation of the No Surprises Act has made the problem it intended to fix worse. He said the flawed implementation is “resulting in more medical providers no longer covered under health insurance networks.”
Sept. 26, 2023: Federal departments sought to raise the administrative fee to enter the No Surprises Act arbitration process from $50 to $150 in 2024.
Dec. 18, 2023: The federal government issued a final rule setting the fee to enter the No Surprises Act arbitration process at $115. The rule mandates that the administrative fee amount will be established no more than once per calendar year.
Jan. 23, 2024: An appeals court partially revived Daniel Haller, MD, and the surgeons at Rockville Centre, N.Y.-based Long Island Surgical PLLC’s lawsuit challenging the No Surprises Act as unconstitutional.
Feb. 15, 2024: CMS released a report that revealed there were 288,810 No Surprises Act disputes initiated during the first six months of 2023, which was 13 times greater than federal agencies initially anticipated.
March 26, 2024: The American Society of Anesthesiologists, along with other physician groups, filed its fifth amicus brief supporting Texas Medical Association’s lawsuit challenging the federal government’s implementation of the No Surprises Act.
July 12, 2024: In CMS’ first audit of an insurer’s No Surprises Act compliance, Aetna was found to have failed to accurately calculate qualified payment amounts for air ambulance services.
Aug. 24, 2024: A report from CMS detailed the most common complaints related to No Surprises Act and ACA compliance. These complaints include surprise billing for both emergency and non-emergency services by providers, payment noncompliance by payers and late payments after independent dispute resolution determination.
Sept. 13, 2024: Bipartisan legislation was introduced to improve enforcement of the No Surprises Act.
Sept. 27, 2024: The American Association of Nurse Anesthesiology filed a petition with a U.S. district court urging Xavier Beccera, then HHS secretary, to enforce the provider nondiscrimination provision of the ACA against insurance companies and health plans. The nondiscrimination provision was passed in 2010 to prevent payers from discriminating against providers on the basis of licensure. The 2020 No Surprises Act required HHS to enforce those policies within one year, but the AANA contends there is still no enforcement in place.
April 7, 2025: A New York federal judge dismissed an antitrust lawsuit against UnitedHealthcare and MultiPlan (now Claritev) that alleged the companies conspired to slash reimbursement rates to Long Island Anesthesiologists by more than 80% after the No Surprises Act took effect in January 2022.
May 30, 2025: Elevance Health, parent company of Blue Cross Blue Shield of Georgia, filed a lawsuit against billing company HaloMD, Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency Medicine of Georgia, alleging the three organizations exploited the IDR process for financial gain. The lawsuit claims the disputes were falsely certified as eligible and structured to secure payments above market rates. Nearly 70% of disputes resulting in provider payments were allegedly not qualified for arbitration.
June 12, 2025: The 5th Circuit Court of Appeals sided with insurers over air ambulance companies, ruling that the No Surprises Act does not grant a private right of action to enforce IDR awards in court unless there is clear evidence of fraud or misconduct. The court also ruled that third-party IDR entities are immune from lawsuits, providing insurers with legal protection against disputes over arbitration outcomes.
July 24, 2025: The American College of Radiology, American College of Emergency Physicians and American Society of Anesthesiologists express support for the No Surprises Enforcement Act. The legislation would impose a penalty three times the difference between the insurer’s initial payment and the IDR arbiter’s ruling per claim, which would also be subject to interest.
