No Surprises Act Prevented 9M Surprise Bills

Research by America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) looks at the effects of the law.

The No Surprises Act (NSA) successfully protected more than nine million Americans from surprise bills in the first nine months since going into effect, according to new data by AHIP and BCBSA.

However, the unintended results of the law have been a boom in claims to the federal independent resolution process (IDR). The survey found that providers have submitted over 275,000 arbitration claims, nearly 10 times more than originally anticipated.

The IDR process is meant to serve as a last option when providers and insurers cannot reach an agreement on fair reimbursement. Excessive use of the process creates unnecessary costs.

"A health care emergency should not lead to a financial crisis. The No Surprises Act has now protected 9 million Americans from receiving costly surprise medical bills from care providers—a huge win for patients," said David Merritt, senior vice president of policy and advocacy for BCBSA.

"However, the tens of thousands of arbitration claims filed by providers clearly demonstrate that more needs to be done to ensure that they don’t abuse the system for their financial gain. We'll continue to work on behalf of patients to protect everyone from surprise medical bills—and lower health care costs with an effective resolution process."

To collect the data, AHIP and BCBSA fielded a nationwide survey to 84 insurers with group health plans and qualified health plans, with 33 payers, making up 57% of the total commercial market, responding.

Using the insurers' commercial enrollment and number of claims between January and September this year, researchers reached a national estimate on the number of NSA-eligible claims (9,367,031) and claims submitted to IDR (275,245).

While the research suggests the NSA is working as intended, another survey by Morning Consult from June found that one in five patients received a surprise bill in 2022. Those bills have been especially costly in some cases, with 22% of respondents saying their chargers were over $1,000.

Meanwhile, the IDR process has continuously been under the spotlight as providers have been unhappy with the rule, claiming it favors payers by heavily factoring in the insurer-calculated qualifying payment amount.