Surprise, Surprise – The No Surprises Act Faces Significant Challenges

In a publicly lauded move, Congress enacted The No Surprises Act (the "Act") to end the balance billing of patients and protect insured patients from surprise bills for emergency services by out of network providers. However, the move has been met with significant resistance from individual providers and medical associations, including the Texas Medical Association (TMA), the American Medical Association (AMA) and the American Heart Association (AHA).

Underlying Dispute and ADR Process and Material Definitions

The Act created a procedural structure under which providers submit a bill for out-of-network services to insurers, and insurers have thirty days to make an initial payment or issue a notice of denial. This new procedure largely leaves the patient outside of the payment dispute for out-of-network services. If the provider wants to dispute the insurer's determination, the provider can open a 30-day open negotiation period during which the insurer