16,000 No Surprises Act complaints yield $4M in relief

As of June 30, 2024, CMS has fielded more than 16,000 complaints related to the No Surprises Act and closed 12,700 of them, the agency said in its most recent "Complaint Data and Enforcement Report."

That totals more than $4.18 million in monetary relief paid to healthcare consumers, according to the report.

The No Surprises Act went into effect in January 2022 to help address the issue of surprise medical billing, defined as the instance of a patient receiving a medical bill they did not expect to get or to be so high.

The Act requires healthcare organizations and facilities to provide a cost estimate for certain healthcare services. If patients receive a surprise medical bill, the No Surprises Act requires the provider and payer to work it out between themselves. When a resolution cannot be reached, the law requires payers and providers to engage with a neutral third party through the independent dispute resolution (IDR) process.

This latest report, issued on August 20, 2024, showed the impact of complaints under the No Surprises Act, Mental Health Parity and Addiction Equity Act (MHPAEA) and Affordable Care Act (ACA) to date.

In total, CMS has received 16,073 complaints. Most of those complaints were related to the No Surprises Act (12,077), while 31 were related to MHPAEA compliance and 248 to ACA compliance.

Of the No Surprises Act complaints, most related to providers, facilities and providers of air ambulance services (10,300). Types of complaints included issues with good faith estimates, surprise billing for nonemergency services at an in-network facility as well as for emergency services.

Meanwhile, 1,777 related to nonfederal governmental plans and issuers. Types of complaints included those about non-compliance with Qualifying Payment Amount requirements, late payment after IDR determination and noncompliance with 30-day Initial Payment or Notice of Denial of Payment requirements.

CMS has closed most of the complaints it has received, with 12,700 being listed as closed and 3,373 being currently open.

And, notably, enforcement of the No Surprises Act has churned up savings for healthcare consumers and providers, who bear the brunt of surprise medical bills. In total, No Surprises Act enforcement has generated more than $4.18 million in monetary relief paid out to healthcare consumers or providers.

These numbers are up slightly from the May report from CMS. In the report, the agency said it had fielded 14,324 complaints as of March 31, 2024. Most of those complaints related to the No Surprises Act and closed complaints generated $3.46 million in monetary relief, the agency said.

Sara Heath has covered news related to patient engagement and health equity since 2015.