TL/DR –
The No Surprises Act was established by Congress to protect patients from unexpectedly high medical bills for emergency and certain non-emergency services from out-of-network providers. Since its implementation, more than 3.3 million disputes have been initiated, exceeding projections, with providers, especially private equity-backed ones, initiating and winning the majority of disputes and often securing awards more than 300% above the qualifying payment amount. Critics observe that providers exploit the system by filing disputes in bulk to pursue higher reimbursement rates, and warn of potential increases in healthcare costs for patients as insurers may raise premiums to offset arbitration losses and hospitals increase prices as leverage in future disputes.
Understanding the Impact of the No Surprises Act on Medical Billing
Experts discuss the ongoing influence of the No Surprises Act, enacted by Congress on December 27, 2020, to safeguard patients from unforeseen high medical bills for emergency services. The key aim is to avoid the financial shock of bills when patients unintentionally receive care from out-of-network providers and insurers refuse to cover the full amount. The Act mandates insurers to cover emergency services without patient authorization for out-of
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