Patients can face high medical bills after a health crisis, when emergency transport and care are necessary and using their insurance network providers isn’t possible. Balance billing, the practice of insurance companies charging patients for the difference between in-network and out-of-network medical expenses, can be financially devastating for consumers and create debt for insurers and providers.
The 2022 No Surprises Act is significant legislation designed to protect consumers from unexpected medical bills, and, it is hoped, reign in health care spending.
We interviewed more than 30 health care industry stakeholders, including federal and state regulators, insurers, providers, and consumer advocates, to discover whether the No Surprises Act is protecting patients from the most pervasive forms of balance billing and from payment disputes between providers and payors.
We find that providers and payors have responded to the legislation by adjusting operations to mitigate the risk of balance billing. Still, interviewed stakeholders see reasons for caution and close monitoring of responses to the law, citing concerns about consumer awareness, insurance literacy, and billing lags, to ensure consumers are fully protected.
Stakeholders say it is too early to assess whether the No Surprises Act will constrain growth in health insurance premiums and encourage insurers to broaden provider networks.