The Coalition Against Surprise Medical Billing launched a “six-figure” ad campaign on Monday that calls on policymakers to reject the No Surprises Act Enforcement Act, which the organization argues will reward the stakeholders abusing the independent dispute resolution process.
The No Surprises Act protects patients from surprise medical bills by requiring insurers and providers to first attempt 30 days of negotiations before either side can take payment disputes to the independent dispute resolution (IDR) process, where a neutral arbitrator selects one of the parties’ payment offers.
However, many in the industry argue that the IDR process is being abused by some providers. What was intended to be a last resort for resolving payment disputes has instead seen an explosion in cases, with providers winning the vast majority of cases at significantly inflated levels. Many also argue that the IDR system is being weaponized by private equity-backed providers.
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According to the Coalition Against Surprise Medical Billing, which represents employers and health insurers, the No Surprises Act Enforcement Act would “double down” on these flaws by:
- Imposing extra costs on employers and health plans, with interest, for any delay in final payments
- Failing to address alleged abuse of the IDR process by some IDR middlemen and private equity-backed providers, including the submission of ineligible claims
- Preserving financial incentives that encourage arbitrators to process more disputes, contributing to a backlog and higher out-of-network payments
“The No Surprises Act Enforcement Act blatantly rewards the costly abuse of IDR by adding new financial penalties plus interest on top of awards — however inflated — that likely shouldn’t have been eligible for IDR in the first place. It does nothing on the flood of ineligible disputes. Nothing on runaway awards,” the Coalition said. “Nothing on bad-faith batching. Nothing on the conflicts of interest of IDR entities that profit from every finalized dispute.”
The launch of the campaign comes after a recent New York Times investigation found that some surgical assistants used the IDR process to earn significantly more than the surgeons they assisted. In one case, a surgeon who removed a cancerous prostate was paid $1,843, while the assistant received $50,456.
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The Coalition is instead calling for clear guardrails on awards, automatic eligibility screening for the IDR process, penalties for bad-faith initiation and better oversight of IDR entities.
“Across the country, out-of-network providers are exploiting the No Surprises Act, gaming an arbitration system meant to protect patients, enforcing you to pay higher healthcare costs. Congress passed this law with good intentions. Now it’s being abused. Congress should fix the loophole, not expand it,” the Coalition said in its new video ad.
Photo: KLH49, Getty Images