A 2023 Urban Institutes research report concludes that the 2020 No Surprises Act (NSA) has achieved the goal Congress expressed in passing the legislation: price transparency in medical billing to protect consumers. Researchers creating the report interviewed 32 regulators and stakeholders representing hospitals, payors, billing companies, and consumers. They also analyzed relevant data to measure the effectiveness of the NSA.
The purpose of the NSA was to protect consumers from high unexpected bills for out-of-network medical services, such as life-flight transportation, emergency room care, and procedures performed outside their home networks. Historically, consumers often would face large unanticipated medical expenses when they failed to realize that the care they were receiving was out-of-network.
Before the NSA, employer-sponsored self-funded plans did not have the same protections as fully funded plans, which could appeal “balance bills” to state agencies. In contrast, state agencies had no legal authority to hear self-funded plan member complaints about charges. Now, federal adjudicators handle complaints from members of self-funded plans, which puts self-funded and fully funded plans on level playing fields.
The NSA is protecting consumers from one of the most pervasive forms of balance billing and removing them from the middle of payment disputes between providers and payors. Healthcare providers and payors have avoided the risk of consumers receiving balance bills for services covered by the NSA and ensuring they pay only in-network cost-sharing. Overall, state and federal regulators are reporting few inquiries related to the NSA that indicate violations of the law.
Despite these positive findings, they are preliminary, and only time will tell whether the NSA will truly address all the problems it was designed to combat. For instance, some consumers could still be unknowingly paying balance bills. In addition, some payors and healthcare providers still need to take the steps necessary to process balance bill claims. Furthermore, since the NSA has only been in effect for one year, more claims could be forthcoming.
Finally, the report is very consumer-specific, and it does not speak to how the NSA may or may not be impacting the terms of service provider contracts between plan sponsors and their benefits service providers, an area of legal compliance receiving increased scrutiny in recent months.
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