No Surprises Act Stops 9M Bills, But Disputes Piling Up as Legal Challenges Continue

The No Surprises Act has prevented more than 9 million individuals from receiving surprise medical bills during the first nine months of 2022, according to the results of a survey conducted by Blue Cross Blue shield Association, but the process of how disputes are resolved is facing a legal challenge that could make a growing backlog of claims even worse, according to a published report.

The number of disputes filed in the first six months after the portal was opened is more than was expected to be filed in the first full year, according to the Centers for Medicare & Medicaid Services. A federal court in Texas is scheduled to hear arguments next month in a lawsuit filed by the Texas Medical Association challenging the process that was established to resolve independent disputes. If the judge rules in favor of the TMA and invalidates the rule, that could lead to longer wait times for health insurers and healthcare providers to work out claims where neither side can agree on an appropriate amount for a surprise medical bill.

Some disputes have remained pending for eight months or more, resulting in healthcare facilities not getting paid in a timely manner for services that were provided.

The No Surprises Act went into effect on January 1 and prohibits healthcare providers from billing individuals who have healthcare insurance and were treated at an out-of-network facility from being charged anything more than what their in-network costs would have been. The objective of the law is to keep individuals, many of whom are in emergency situations, from being treated at an out-of-network facility and being billed as if they did not have medical insurance. 

A survey that was released back in the summer revealed that 20% of individuals who visited a healthcare facility this year received a surprise medical bill, and nearly 25% of those bills were in excess of $1,000.

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