"Arbitration Outcomes for Out-of-Network Medical Bills Under the No Surprises Act".

ABSTRACT: The No Surprises Act (NSA), implemented in 2022, has protected patients nationally from surprise medical bills in most settings. However, out-of-network care resulting in arbitration between insurers and providers under the NSA may result in very high costs for this care. The objective of this paper is to characterize payments for out-of-network care resulting from disputes that underwent arbitration under the NSA and compare the settlement amounts to in-network prices. Using 2023 dispute and claims data from Elevance Health (EH), we described insurer and provider bids, and compared the final settlement amounts to the qualifying payment amount (QPA) - which is used in arbitration and is intended to represent average in-network market rates - and to in-network prices for similar procedures.

SUBMITTER: Ukert B 

PROVIDER: S-EPMC12698988 | biostudies-literature | 2025 Jan-Dec

REPOSITORIES: biostudies-literature