HHS report highlights how the No Surprises Act will prevent surprise medical bills faced by millions of Americans

Nov. 23, 2021

A new report from the U.S. Department of Health and Human Services (HHS) highlights that millions of Americans with private health insurance experience some kind of surprise medical billing.

The report, which was written by researchers in HHS's Office of the Assistant Secretary for Planning and Evaluation (ASPE), found that surprise medical bills are relatively common among privately-insured patients and can average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants, and $750 for childbirth-related care. While many states have taken steps to try to address surprise billing, state laws have left critical consumer protection gaps that will be addressed when the No Surprises Act takes effect in 2022.

Consumers often expect their employer-sponsored insurance will shield them from high out-of-pocket costs for emergency services. Unfortunately, the ASPE report reveals that an estimated 18 percent of emergency room visits by individuals with large employer coverage resulted in one or more out-of-network charges, and this percentage varies greatly by state, ranging from a low of 3 percent in Minnesota to a high of 38 percent in Texas. These costs can be quite alarming to consumers. Another finding in the report is that patients receiving a surprise bill for emergency care paid physicians more than 10 times as much as patients without a surprise bill for emergency care.

In the absence of prior congressional action, several states have enacted laws aimed at combatting surprise medical billing. The ASPE report describes how 18 states have comprehensive approaches to address surprise medical billing, while an additional 15 states have taken partial steps. These efforts include establishing standard payment rates to restrict high variation for out-of-network charges and dispute resolution processes to resolve additional payments for which patients may no longer be held responsible. Unfortunately, despite their best efforts, state laws have significant limitations in protecting many patients from surprise medical billing.

Most importantly, state insurance rules do not apply to self‐insured employee benefit plans, which cover 67 percent of workers with employer‐sponsored health coverage. Additionally, research has found that some state efforts to resolve surprise billing payment disputes have resulted in increased health care costs. The Administration’s implementation of NSA are designed to address these gaps in state policies and apply protections against surprise billing nationwide.

Accordingly, in implementing the bipartisan NSA, the Biden-Harris Administration issued a series of regulations that, starting January 1, 2022, will finally provide patients with individual or employer health coverage relief from surprise medical billing and reduce health care costs. Individuals with most individual and employer insurance can no longer be balance-billed for emergency and certain non-emergency services in most circumstances. Patients will be removed from payment disputes that must be settled between providers and insurers. Further, the Congressional Budget Office predicted that the No Surprises Act will reduce health insurance premiums for consumers.

The Administration recently released an interim final rule with comment period detailing the process for resolving disputed claims that takes consumers out of the dispute and ensures they do not end up with surprise bills. The Administration is still welcoming comments on this rule and will carefully review all that it receives.

While the Administration will be collecting more information to further bolster consumer protections and reduce health care costs, today’s ASPE report underscores the need for immediate nationwide protections to ban surprise medical billing.

HHS press release