Reports Show Network Participation Increased With Surprise Billing Ban

  • Feb 23, 2024

    A vocal contingent of providers has argued that the No Surprises Act (NSA), the 2020 law that banned surprise medical billing in most cases, has limited their ability to get fair in-network rates from insurers, disincentivizing network participation. However, experts say that this complaint misses the point of the reform — and recent data indicate that the opposite of what providers argue may be true. 

    The NSA stipulates that when a patient is being treated by an out-of-network provider without having agreed to it first — which often happens in emergency rooms — the provider can only charge the patient their maximum in-network cost sharing amount. If there is an outstanding balance after the patient is billed that amount, the provider has two options for payment: The provider can either accept the median in-network rate for the care in question, or submit the disputed bill to a binding arbitration process called Independent Dispute Resolution (IDR).  

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  • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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