No Surprises Act shielded patients from big medical bills. Now its arbitration system may be raising costs.
The No Surprises Act was intended to stop patients from receiving unexpected bills for out-of-network care. But its dispute process has developed into a profitable business, with some providers and companies representing them securing payments well above benchmark rates.
In arbitration, insurers and providers each submit a proposed price for a service. The arbitrator must pick one of those offers. A CBS News analysis found plastic surgeon Dr. Norman Rowe received awards averaging about 170 times benchmark rates for his services.
Providers win more than 85% of cases, according to Leland Robbins of health data firm Turquoise Health. The process also generates substantial fees: arbitrators have collected more than $2 billion, and 17 are currently designated to handle cases.
Much of the money comes from employer-sponsored health plans. That could affect workers through higher premiums or reduced benefits, with some costs becoming more visible during employers’ annual enrollment periods.
New Jersey Representative Frank Pallone, the act’s lead sponsor, says private equity has helped undermine the system. The article reports that the dispute process continues, while HaloMD, which files cases for providers, challenged an estimate of expected case volume as flawed.
Key points
- The law stopped surprise bills, but arbitration awards can greatly exceed benchmark rates.
- Providers win most arbitration cases, and the process has generated more than $2 billion in fees.
- Employer health plans bear much of the cost, potentially affecting workers’ premiums or benefits.