The No Surprises Act aims to protect patients from unforeseen medical bills, but it is also adding financial burdens for anesthesia providers.
The federal No Surprises Act, which aims to educate patients about healthcare costs in advance of care and prevent unforeseen medical bills, went into effect on January 1, 2022.
Under the No Surprises Act, patients with group and individual health plans are protected from receiving surprise medical bills from most emergency services and certain scheduled services without their consent. Patients who are not insured or are not using insurance to pay for care have the right to receive a good-faith estimate of the cost up front. They also may be able to dispute the charges if they disagree with them.
Under the new legislation, out-of-network anesthesia providers are prohibited from balance billing. If a patient is seeking a surgical service in a facility covered by their insurance plan, but an out-of-network practitioner is providing the anesthesia, the anesthesia provider can’t bill the patient for the difference between what the payer covers and the provider’s rate.
Cost-sharing for all emergency services — and non-emergency services in facilities covered by patients’ insurance plans — are established on an in-network basis. For out-of-network services, cost-sharing is determined by state policies. An out-of-network provider who disagrees with a plan’s payment can try to negotiate it through an independent dispute resolution process.
Many anesthesia providers and professional organizations have expressed concerns about how the No Surprises Act negatively affects providers and patients. In November 2022, the American Society of Anesthesiologists published a statement supporting protections for patients but criticizing how the new law favors payers and puts additional financial burdens on anesthesia providers:
This flawed implementation has led to a significant imbalance that benefits insurance companies while harming physicians, especially small- and medium-sized community-based practices. For example, multiple practices nationwide have reported unresolved payment disputes for services provided 10 or 11 months ago. In other cases, insurance companies have slashed payments to anesthesiologists and other specialists by nearly 40%, forcing anesthesiologists out of health care networks.
If physicians aren’t paid fairly, the financial strain may cause some to close their doors or relocate to a part of the country where practicing their specialty is less expensive. And that means some patients may not be able to receive care at the nearest hospital, or may have to wait months for needed care, especially if they live in a small town or rural area.
Providers are often faced with an unappealing choice: take reduced fees or be dropped from payer contracts (and then accepting qualifying payment amounts, which are usually far lower than contracted rates). Payers retain financial control and keep providers in the dark by not publishing qualifying payment amounts. This imbalance harms anesthesia providers and, ultimately, patient satisfaction and access to affordable care.
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