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Physicians

No Surprises Enforcement Act: A Bipartisan Solution to Insider Abuse

Strategic Insights

— 1 min read

The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists have strongly supported the No Surprises Enforcement Act, a bipartisan legislation aimed at holding insurance companies accountable for violating the No Surprises Act. The act makes critical improvements to enforcement of existing laws, stopping insurer bad behavior and allowing the No Surprises Act to work as Congress intended. The legislation was introduced by a group of lawmakers, including Rep. Greg Murphy, Rep. Jimmy Panetta, and Sen. Roger Marshall, with the goal of imposing a penalty on insurance companies that fail to pay physicians within 30 days after losing an independent dispute resolution process.

Key Takeaways:

  • The No Surprises Enforcement Act aims to hold insurance companies accountable for violating the No Surprises Act, which was designed to keep patients out of billing disputes between payers and providers.
  • The legislation would impose a penalty three times the difference between the insurer's initial payment and the IDR entities' ruling per claim, subject to interest.
  • Insurance companies would be penalized for failing to pay physicians within 30 days after losing an independent dispute resolution process.
  • According to government data, insurance companies lose nearly eight out of 10 IDR cases to physicians or other providers.
  • The legislation would stop insurer bad practices, such as delaying payment or refusing to pay for services provided to patients.
  • The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists have strongly supported the No Surprises Enforcement Act.
  • The legislation would not impact the patient protections included in the No Surprises Act, nor would it raise patient out-of-pocket costs.

Statistics:

  • Insurance companies lose nearly eight out of 10 IDR cases to physicians or other providers (Source: government data).
  • The proposed penalty would be three times the difference between the insurer's initial payment and the IDR entities' ruling per claim, plus interest (Source: H.R. 4710).
  • The legislation would impose a penalty on insurance companies that fail to pay physicians within 30 days after losing an independent dispute resolution process (Source: H.R. 4710).
  • The American College of Emergency Physicians, American College of Radiology, and American Society of Anesthesiologists have strongly supported the No Surprises Enforcement Act (Source: press release).

Sources:

  • American Society of Anesthesiologists
  • American College of Emergency Physicians
  • American College of Radiology
  • H.R. 4710 (No Surprises Enforcement Act)
  • S. 2420 (No Surprises Enforcement Act)

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