No Surprises Act blocks 2 million surprise medical bills in first months of 2022


Figure flies past federal regulators’ initial estimate of 17,000 surprise bills a year.

he federal No Surprises Act (NSA) prevented more than 2 million surprise medical bills for the first two months of 2022 – far more than federal regulators initially estimated.

If the trend continues, the law will block more than 12 million surprise bills to patients this year, according to a projection from AHIP and the Blue Cross Blue Shield Association (BCBSA).

The organizations published their findings based on an April survey of 31 health insurance providers offering commercial health insurance coverage and group health plans covering 115 million commercial enrollees in January and February 2022.

“There is no room for surprise medical bills in a health care system that puts people first,” BCBSA President and CEO Kim Keck said in a news release. “As recently as last year, an emergency visit to the hospital may have left patients on the hook for steep, surprise medical bills. The No Surprises Act has not only put an end to this loophole, but it has provided undeniable financial protection to millions of Americans.”

By the numbers

The federal Departments of Health & Human Services (HHS), Labor and Treasury estimated about 17,000 claims a year would go through the independent dispute resolution (IDR) process established by NSA for payers and providers to resolve disputes over provider payments, according to AHIP and BCBSA.

Their survey found 600,000 claims eligible for IDR in January and February, with that figure likely undercounted due to delays in claims processing. AHIP and BCBSA estimated there were more than 2 million claims eligible for IDR – or surprise bills – in commercial markets in January and February, when calculated with background data from the 2020 Census and the IBM Commercial Claims Dataset.

AHIP, a Washington, D.C.-based health insurance trade group, and BCBSA, the federation of 34 Blue Cross and Blue Shield health insurance companies, said the findings demonstrate “how many patients and consumers have already benefited from the NSA and how important the current IDR process will be in establishing predictability in overall costs.”

Consumer protection

The NSA was signed into law in December 2020, with most of its provisions taking effect at the beginning of 2022, according to the AHIP and BCBSA study.

The law was heralded as a landmark consumer protection that would help control costs of health care. Consumer advocates, health insurance groups and physicians organizations have lined up for various court cases challenging parts of NSA.

In February, a federal court ruled in favor of the Texas Medical Association’s legal claim against the IDR process. The federal Centers for Medicare & Medicaid Services noted the ruling did not overturn the consumer protections from surprise bills.

“The No Surprises Act ended the practice of surprise medical billing in most circumstances, providing relief for millions of patients who faced surprise medical bills they did not expect at prices they could not afford,” AHIP President and CEO Matt Eyles said in a news release. “Health insurance providers applaud the Administration and Congress for taking this important step. But more work needs to be done to ensure a broken bone doesn’t break the bank.”

This article originally appeared on Medical Economics®.

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