Bills, especially large health related ones, are never particularly cherished. That’s why when Congress passed the No Surprises Act in December 2020, consumer advocates lauded it as a first step toward patient protection against exorbitant medical bills. A recent Biden administration rule detailing the federal arbitration process, however, ignores provisions in the legislation. This may ultimately result in inadequate reimbursement rates unfairly imposed by the government on clinicians, thereby reducing quality and access for patients.
The No Surprises Act bans surprise billing for emergency services, certain out of network non-emergency care at in-network facilities, and limits high out-of-network cost-sharing. It also establishes a process for determining the amounts clinicians should be reimbursed in the case of these out-of-network medical bills. This starts with negotiations between insurers and clinicians and, if negotiations are unsuccessful, an independent dispute resolution (IDR) process is deployed.
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