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Article Summary
The No Surprises Act, enacted in 2022, protects consumers from unexpected medical bills by establishing an Independent Dispute Resolution (IDR) process for out-of-network payment disputes between providers and payers. A recent analysis by KFF reveals that nearly two-thirds of disputes involve emergency room care, with private equity-backed providers like TEAMHealth, SCP Health, and Radiology Partners accounting for over half of the disputes. While the Act shields patients from surprise bills, it may not reduce overall healthcare costs. The findings are available on the Peterson-KFF Health System Tracker, a resource for monitoring U.S. healthcare performance.
What This Means for You
- You are less likely to face surprise medical bills for out-of-network emergency care, thanks to the No Surprises Act.
- If you receive care from providers like TEAMHealth or Radiology Partners, be aware they are frequent participants in payment disputes.
- Monitor your medical bills closely to ensure compliance with the Act and report any discrepancies to your insurer or provider.
- Expect ongoing debates about the Act’s effectiveness in reducing healthcare costs, as its long-term impact remains uncertain.
The Performance of the Federal Independent Dispute Resolution Process through Mid-2024
The No Surprises Act, which was signed into law by President Trump during his first term and took effect in 2022, aims to protect consumers from certain surprise medical bills. The law established processes to keep the patient out of the payment negotiations between the provider and the plan. In the event of an unsuccessful negotiation, providers and payers enter an independent dispute resolution (IDR) process in which a designated third-party arbitrator examines eligible evidence from both parties to decide on a final payment rate.
KFF’s analysis examines the implementation status of the IDR process and discusses some of the impacts on providers, payers, and ultimately, consumers, with some key findings, including that nearly two in three disputed services involved care that was furnished in an emergency room. The top 10 dispute-initiating parties are all providers or their billing consultants, and they submitted 72% of the out-of-network payment disputes from 2023-mid-2024. The top three parties accounted for 53% of payment disputes from the beginning of 2023 through mid-2024: TEAMHealth, SCP Health, and Radiology Partners, all of which are backed by private equity firms. While the No Surprises Act is protecting consumers from surprise bills, it is likely not reducing prices and spending.
The analysis is available through the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.
People Also Ask About
- What is the No Surprises Act? A U.S. law designed to protect patients from unexpected medical bills for out-of-network care.
- How does the IDR process work? A third-party arbitrator reviews evidence from providers and payers to determine a fair payment rate.
- Who initiates most payment disputes? Private equity-backed providers like TEAMHealth and Radiology Partners.
- Does the No Surprises Act reduce healthcare costs? It protects patients but may not lower overall healthcare spending.
- Where can I find more information? Visit the Peterson-KFF Health System Tracker for detailed analysis.
Expert Opinion
The No Surprises Act represents a significant step toward protecting consumers from unexpected medical bills, but its impact on reducing healthcare costs remains limited. The dominance of private equity-backed providers in payment disputes highlights the need for further reforms to address systemic issues in healthcare pricing and transparency.
Key Terms
- No Surprises Act 2022
- Independent Dispute Resolution process
- Out-of-network medical bills
- Private equity-backed healthcare providers
- Peterson-KFF Health System Tracker
- Emergency room payment disputes
- Healthcare cost transparency
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