Clinicians Lose more than they Can Expect to Gain when Challenging Insurer Payments Under the No Surprises Act
Harvey L. Neiman Health Policy InstituteA new Harvey L. Neiman Health Policy Institute study found that clinicians who dispute insurer payments under the No Surprises Act (NSA) will typically pay fees in excess of recovered payments. Across affected medical specialties, only one-half to two-thirds of out of network (OON) claims would result in any net return if submitted through the NSA’s Independent Dispute Resolution Process (IDR) process, demonstrating this is not a financially viable option to resolve payment disputes. This American Journal of Roentgenology study was based on 1.5 million commercial OON claims (2017-2021) for individuals covered by a large commercial payer and focused on specialties most affected by the NSA: anesthesiology, emergency medicine, hospitalist, intensivist, laboratory, neonatology, pathology, and radiology.