No Surprises Act
Coverage of No Surprises Act in the Nexus archive.
- Op-ed | Health plans take aim at independent dispute resolution cases; tips for providers
The number of Independent Dispute Resolution (IDR) cases under the No Surprises Act has surged, with out-of-network providers winning over 80% of cases. Health plans are increasingly challenging providers, who face tactics to mitigate their success. Over 3.3 million IDRs were filed in 2024, with providers securing median payments 450% above the Qualified Payment Amount.
- STAT+: HaloMD faces lawsuit alleging No Surprises Act middleman used ‘sham letter,’ misleading data
Highmark Health, a Blue Cross Blue Shield licensee, is suing HaloMD and its client Bromedicon for allegedly using the No Surprises Act's arbitration process to submit over 450 ineligible disputes, securing $3.9 million in awards through deceptive practices like a 'sham letter' and misleading data. Highmark seeks to void the awards and reclaim the funds, accusing the defendants of deliberately extracting inflated payments.
- STAT+: No Surprises Act arbitration rule could worsen flood of provider disputes
The Trump administration finalized changes to the No Surprises Act’s arbitration process, aiming to improve insurer-provider communication and increase Medicare visibility in negotiations. While stakeholders praised the updates, concerns remain about unresolved issues like provider gaming and excessive arbitration awards.
- After Her Bout of Amnesia, a $59,000 Billing Dispute Wouldn’t Go Away
Jan Anderson experienced transient global amnesia after a hike in Sedona, Arizona, leading to emergency hospitalization. She received $59,181 in medical bills from Abrazo Health, which her insurer, Molina Healthcare, partially adjusted but left her with a $15,312 debt. The billing dispute involves the No Surprises Act, which should cover out-of-network emergency care.
- 3 steps that could stop fraud and make healthcare more affordable for all Americans
The article outlines three steps to reduce healthcare costs and fraud in the U.S., including providing patients with upfront pricing through the Advanced Explanation of Benefits (AEOB) and reforming the Federal Employees Health Benefits Program. It criticizes the Biden administration for not implementing the AEOB and highlights President Trump's TrumpRX platform as a model for transparency.
- STAT+: This spine surgery usually costs $1,400. Under No Surprises Act arbitration? $34,000
The No Surprises Act's arbitration process is resulting in out-of-network providers receiving significantly higher prices for spine surgery, with median prices reaching $34,000, compared to the usual $1,400. This has been a major benefit for providers, who are prevailing in over 80% of disputes. The law has protected patients from unexpected bills but has also led to high awards for providers.
- STAT+: Provider, insurer groups rush to shape No Surprises Act arbitration rules
The federal government is set to unveil changes to the No Surprises Act's arbitration process, with health care providers and insurers meeting with officials to shape the rules. The departments of Health and Human Services, Labor, Treasury, and the Office of Personnel Management released an initial version of the rule in November 2023. Providers have had more meetings with officials than insurers.