Providers and payers continue to wage war over how the No Surprises Act is being implemented.
The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services.
At the heart of the debate is the process’s Qualifying Payment Amount, or QPA. Providers and payers continue to disagree about how that amount is determined and how it is interpreted in the Independent Dispute Resolution process.
Meanwhile, providers are faring far better in that process than insurers, winning somewhere between 70 and 82 percent of all disputes that go to arbitration. Providers owned by private equity have proven especially successful in winning their disputes.
Learn more about the continuing controversy over the implementation of the No Surprises Act from the recent Washington Post story “The arms race over surprise bills.”