No Surprises Act largely protecting patients, but gaps remain: Report

The No Surprises Act is largely protecting patients from the most pervasive forms of surprise billing, but the gaps that do remain have left some with unexpected financial liabilities, according to an April 18 report from the Urban Institute and the Georgetown University’s Center on Health Insurance Reforms, with funding from the Robert Wood Johnson Foundation. 

Researchers conducted 32 interviews with federal and state regulators and organizations representing stakeholders such as consumers, employers, physicians, hospitals, payers and medical billing companies, according to the report. The interviews were conducted between Oct. 1, 2022, and Jan. 31. 

Because the implementation of the independent dispute resolution process has been delayed by startup challenges and ongoing litigation, the report does not focus on that process.  

Here are four key findings, according to an April 18 Robert Wood Johnson Foundation news release:

1. Despite multiple lawsuits challenging the implementation of the No Surprises Act, patients appear to be well-protected from the most pervasive balance billing practices — such as billing for air ambulance services — that previously left them with unexpected medical bills. 

2. The No Surprises Act does not include ground ambulance services in provider networks, meaning many people will continue to be billed for out-of-network services incurred in an emergency. 

3. Researchers said it is too early to assess whether the No Surprises Act will encourage broader provider networks or constrain health insurance premium growth. 

4. Close monitoring of the No Surprises Act is needed, with concerns about consumer awareness of its provisions. 

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