What’s the news: A bill sponsored by Republicans and Democrats and introduced in both the House of Representatives and the U.S. Senate aims to address the widespread problem of health plans failing to comply with the No Surprises Act’s clear payment requirements—particularly after physicians prevail in the independent dispute-resolution process.
The legislation, called the No Surprises Act Enforcement Act (H.R. 4710/S. 2420), would authorize penalties for any party that does fails to comply with statutory payment timelines following a final and binding independent dispute-resolution determination. The legislation also would provide federal regulators with explicit authority to enforce such decisions, helping restore the balance Congress intended when it enacted the No Surprises Act in 2020 and ensuring greater accountability throughout the process.
In a letter sent to congressional leaders (PDF) in May, the AMA, 50 state medical societies and 46 healthcare groups announced support for the bipartisan bill.
“Our organizations remain fully committed to the core purpose of the No Surprises Act: protecting patients from surprise medical bills while ensuring physicians and other healthcare providers receive fair and timely payment for the medical services they provide,” the letter says. “We remain deeply invested in this law’s successful implementation and in achieving the balanced framework Congress intended.”
The AMA fiercely advocated to shape that law to protect patients while fairly balancing the process for physicians and health plans to settle disputes over out-of-network payments. The AMA was actively involved in ensuring that implementation of statute adhered to the letter of the law.
Why it’s important for patients and physicians: The No Surprises Act is unambiguous: independent dispute-resolution determinations “shall be binding upon the parties involved,” says the letter. Despite this clear requirement, insurers have too often treated final payment determinations as optional.
The impact of this failure to enforce the No Surprises Act has been widespread.
“Physician practices are forced to absorb unpaid costs, finance delays, and shoulder uncertainty while insurers retain funds they are legally obligated to pay,” says the letter from the AMA and others.
Physicians across the country report that health plans continue to bill patients improperly, delay payments beyond the statutory 30-day timeframe and or refuse to pay altogether, with a 2024 survey by the Emergency Department Practice Management Association finding significant noncompliance. Nearly one in four—24%—of emergency department practice respondents reported that their independent-dispute resolution awards were either unpaid or paid incorrectly within the 30 business days required by the No Surprises Act.
These practices place significant financial strain on independent physician practices that have limited ability to challenge insurers’ noncompliance. The May letter to congressional leaders follows a separate, April letter (PDF) from the AMA and 111 specialty societies and state medical association to administration officials warning about health plans are undermining the No Surprises Act and urged federal regulators to increase enforcement and transparency.
Learn more: Earlier this month, AMA President Bobby Mukkamala, MD, detailed in a Leadership Viewpoints column why better enforcement of the No Surprises Act is needed now.
The AMA offers detailed guidance for physicians on implementation of the No Surprises Act, providing physician toolkits and updates on federal rulemaking and ongoing litigation.
These AMA resources include a comprehensive guide on disputing out-of-network payments using the law’s independent-dispute resolution process (PDF).
