The U.S. Department of Health and Human Services (HHS) has issued a new report on the effects of the No Surprises Act independent dispute resolution (IDR) system. According to the report, the average dispute took 91 days to resolve, with some lasting more than 300 days. The outcome of the dispute-resolution process also caused sticker shock for some employer-sponsored health insurance plans. Ultimately, the report concludes that the IDR system is expensive, slow, and delivers stronger advantage to healthcare providers.
In the report, HHS also found that IDR reviews cost an average of $445. In cases involving hospital care, reviewers ruled in favor of healthcare providers 80% of the time. Those decisions also resulted in extremely high payment rates for providers. For instance, the average anesthesia award for a colonoscopy was quadruple the rates paid by a typical commercial plan, or $1,252 on average. Likewise, an award for a tissue examination by a pathologist averaged $161, compared with the average commercial payment of $51.
The No Surprises Act was intended to prevent certain cases of balance billing. Under the Act, providers and payers must resolve certain billing disputes through the IDR process to prevent patients from receiving expensive bills for out-of-network care. Covered types of care include emergency care at out-of-network hospitals and air ambulance services. Care performed by out-of-network providers at in-network hospitals, such as radiologists and anesthesiologists, also falls within the purview of the Act.
Despite its slow pace and expensive awards, analysts at America’s Health Insurance Plans and the Blue Cross Blue Shield Association concluded that the Act has protected patients from about 1 million unexpected medical bills per month. When the Act applies, bills are resolved through the IDR system without requiring patient payment.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.
