What’s the news: The AMA is backing recently introduced bipartisan legislation to help address shortcomings in the independent-dispute resolution process established under the 2020 No Surprises Act.
The legislation—called the No Surprises Act Enforcement Act (H.R. 4710; S. 2420)—was introduced in late July by Sens. Roger Marshall, MD (R-Kan.) and Michael Bennet (D-Colo.) and Reps. Greg Murphy, MD (R-N.C.), Kim Schrier, MD (D-Wash.), John Joyce, MD (R-Pa.), Jimmy Panetta (D-Calif.), Bob Onder, MD (R-Mo.), and Raul Ruiz, MD (D-Calif.).
The measure comes in response to reports that many health plans fail to adhere to statutory timelines for payment after an independent-dispute resolution entity has made a final and binding determination, and the bill would allow penalties on parties that don’t pay up. If enacted, the measure would help enforce independent-dispute resolution decisions and reestablish the balance achieved in the No Surprises Act. The legislation also imposes additional reporting requirements on the governmental agencies charged with enforcement of the statute.
Why it’s important: The No Surprises Act was signed into law in 2020 to address unexpected gaps in insurance coverage that result in “surprise medical bills” when patients unknowingly obtain medical services from physicians and other providers outside their health insurance network.
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.
Unfortunately, many health plans fail to abide by the law after an independent-dispute resolution determination. A 2024 survey by the Emergency Department Practice Management Association found 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 Suprises Act (NSA). This is a clear violation of the law’s statutory requirement that an independent-dispute resolution determination “shall be binding upon the parties involved.”
As AMA CEO and Executive Vice President John J. Whyte, MD, MPH, wrote in a supportive letter to Sens. Marshall and Bennett (PDF), “Nothing could undermine the success of the NSA more than having independent-dispute resolution (IDR) decisions ignored by losing health plans.”
Learn more: 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).
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