Arbitration Outcomes for Out-of-Network Medical Bills Under the No Surprises Act
This study examining final payments for out-of-network care in 2023, following arbitration under the No Surprises Act, found that not only were payments higher than Medicare rates, but they were also two to three times higher than payments to in-network providers for the same services.
The No Surprises Act (NSA), implemented in 2022, has protected patients nationally from surprise medical bills in most settings. However, out-of-network care resulting in arbitration between insurers and providers under the NSA may result in very high costs for this care. In addition to the higher final payment rates awarded under arbitration, this study found that out-of-network providers won 80% of disputes in 2023.
These results, published in INQUIRY: The Journal of Health Care Organization, Provision, and Financing, challenge Congressional Budget Office projections that expected arbitration outcomes to align with in-network rates and reduce healthcare spending.
Related Public Policy Research
Provider Charges and State Surprise Billing Laws: Evidence from New York and California
This study published in Health Affairs examined how out-of-network (OON) provider charges changed following the passage of New York and California’s surprise billing laws compared with states without a surprise billing law.
Estimating Surprise Bills Among Members of Commercial Health Insurance
Potential surprise bills occurred for 1.8 percent of members and 6.2 percent of episodes in 2018. Emergency episodes had a higher rate of potential surprise bills than non-emergency care.