All articles tagged with #no surprises act
The No Surprises Act successfully eliminated surprise patient bills but created a lucrative arbitration system that is driving up healthcare costs. Providers are winning awards far above benchmark rates, with costs shifting to employer-sponsored plans and potentially raising premiums.
A coalition of large self-funded employers warns Congress that the 2020 No Surprises Act is driving up health-insurance costs and arbitration disputes, potentially boosting premiums. The ERISA Industry Committee—whose members include ExxonMobil, Walmart, and others—pushed for reforms to curb dispute costs and change price benchmarks, as lawmakers hold roundtables and consider amendments ahead of a lame‑duck session.
The No Surprises Act has protected patients from surprise bills, but arbitration payouts have ballooned—2.5 million claims last year and about $15 billion in awards—fueling a stalemate between doctors and insurers over fixes. Lawmakers across the aisle say action is needed, but consensus remains elusive: Rep. Greg Murphy seeks harsher penalties on insurers who don’t pay arbitration judgments, insurers push back against overreach, and CMS has issued rules to streamline the process while advocates argue broader reform is still required.
Rate filings from 77 ACA Marketplace insurers across 16 states/DC show a median 14% proposed increase for 2027, continuing a double-digit rise driven by higher medical costs (about 10% trend), inflation, labor shortages, GLP-1 drug costs, and the expiration of enhanced premium tax credits that raised morbidity in 2026. Some insurers seek more than 20% hikes; final rates will be set in late summer, with many enrollees still subsidy-eligible but facing a larger subsidy cliff that raises net premiums.
A 36-year-old West Palm Beach man with an aggressive brain tumor was initially denied Florida Blue coverage for out-of-network surgery at Tampa General Hospital, but after investigative reporting the insurer reversed course, agreeing to cover preoperative workup, the surgery, hospital admission, and postoperative care. The case, linked to a radiation-associated meningioma from childhood leukemia treatment, underscores the No Surprises Act protections and the impact of media scrutiny in navigating medical billing.