A bipartisan group of lawmakers, including five medical doctors, has introduced a bipartisan bill in the House to enforce provisions of the No Surprises Act. The bill could increase the maximum penalties for employer health plans for delayed payments from a No Surprises Act claim to $10,000. The current penalty is $100. Furthermore, the bill would require federal officials to annually report their work to ensure health plan compliance with the Act.
The No Surprises Act requires health plans and healthcare providers to shield patients from "balance billing," or extra, unanticipated bills. These bills often arise when patients get emergency care or get care from in-network hospitals but ultimately receive services from out-of-network radiologists or other providers.
Currently, the Act can result in a maximum penalty of $10,000 for medical providers who send a patient a bill that violates the law. Health plans can incur fines of $100 per violation per day.
Employer groups, including the ERISA Industry Committee (ERIC), claim that medical providers are utilizing the No Surprises Act to increase claims, despite the existing spike in health plan costs. However, the bill's co-sponsors cite the legislation as necessary to hold big insurance companies accountable for properly paying claims. Their stated goal for the bill is to ensure that insurance companies promptly resolve out-of-network medical bills or face high sanctions when they fail to do so.
A 2024 survey from the Emergency Department Practice Management Association found that almost a quarter of survey respondents reported that health insurance companies failed to pay or incorrectly paid independent-dispute resolution (IDR) awards within 30 days. These refusals to pay the correct amount clearly violate the No Surprises Act and undermine its purpose.
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