The No Surprises Act aims to prevent surprise billing by implementing an independent dispute resolution process for payment disputes between payers and out-of-network providers.
While providers win the majority of IDR resolutions, there have been several court rulings and new lawsuits in recent months that could have significant implications for the future of the law.
Here are five updates on the No Surprises Act:
1. The American College of Radiology, American College of Emergency Physicians, and American Society of Anesthesiologists expressed support for the No Surprises Enforcement Act in a July 24 news release. 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.
2. Providers won between 83% and 88% of IDR cases in the first half of 2024, according to a June study published in Health Affairs. Providers often secured much higher amounts than insurers, with the median prevailing offer in some cases reaching 447% of the qualifying payment amount. The IDR process remains concentrated in Texas, Florida and Arizona, and among large provider groups, with third-party companies emerging to help smaller providers navigate the process.
3. In June, 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.
4. In May, 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.
5. In April, 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.
