Pay Bills

Insurers estimate that the No Surprises law blocked 2 million invoices in two months

The no-surprises law protected private policyholders from around 2 million surprise bills in the first two months of the year, according to a report by health insurance industry groups on Tuesday.

AHIP and the Blue Cross Blue Shield Association surveyed more than 80 commercial health insurance companies, of which 31 responded. These insurers represent 115 million members of commercial health plans.

These companies said they received 600,000 claims covered by the Surprise Billing Act in January and February. Based on claims experiences from previous years and taking into account processing delays this year, insurance groups estimate the actual amount of these bills to be 2 million.

AHIP and the Blue Cross Blue Shield Association predict the new rules could prevent more than 12 million surprise bills this year.

Before President Donald Trump passed the No Surprises Act in 2020, two-thirds of adults said they worried about whether they could afford surprise medical bills, according to a Kaiser Family Foundation Poll.

The law, which took effect on January 1, aims to protect patients from unexpected medical bills, including those issued by out-of-network healthcare professionals working in in-network facilities. Law enforcement regulations require independent dispute resolution to resolve billing disputes between insurers and providers without patients needing to be involved.

Payers and providers have fought over the details of this process as each side seeks to defend its financial interests.

“The law strives to protect millions of consumers from costly surprise bills, yet several hospital organizations and providers have filed lawsuits challenging the [No Surprises Act] regulations and legislation in order to increase their own profits at the expense of patients”, insurance groups report said.

In February, a federal judge ruled that the independent dispute resolution process gives insurers an unfair advantage over providers when determining final payment amounts. Suppliers want more bargaining power to decide their remuneration.

“This new approach that is in law gives patients certainty,” said Chip Kahn, president and CEO of the Federation of American Hospitals. But the current method of determining how to reimburse providers can lead to underpayments, he said. “Hospitals and clinicians will be harmed by insurers who hide behind regulation to underpay for services,” he said.

In April, the Centers for Medicare and Medicaid Services revised their guidelines on what arbitrators can consider when determining appropriate payments. In addition to median contracted rates for services, providers and insurers can submit information on providers’ level of education, providers’ regional market share, patient acuity and other relevant factors, CMS advised. .