The No Surprises Act (NSA), passed by Congress in 2020, was designed to protect Americans from large, unexpected medical bills, particularly those incurred during medical emergencies when a patient’s only choice may be seeking out-of-network care. By preventing insurers from requiring patients to pay these large surprise bills, the law has alleviated financial strain for millions. A report indicates that patients avoided around 10 million surprise bills in the first nine months of 2023.  

Despite these successes, the NSA has introduced a complex system for resolving payment disputes between insurers and medical providers. This arbitration process, intended to be a fair mediator, has instead led to a backlog of cases and significant delays in payment. As a result, some physicians claim that insurers are leveraging the system to reduce payments unfairly, while insurers argue that certain physician groups are exploiting the process for higher payouts. 

These ongoing disputes pose potential risks, including higher insurance premiums for all and reduced availability of physicians, particularly in rural areas. These two potential outcomes are frightening, as the cost of healthcare in the United States is already significantly higher than in other wealthy countries, and the United States is also already facing a significant physician shortage. The situation underscores the need for further refinement of the NSA implementation to ensure that its benefits are not undermined by administrative inefficiencies and disputes. As the healthcare industry navigates these challenges, the goal remains to protect patients from unexpected financial burdens, to ultimately protect the business of healthcare for all.