The No Surprises Act, which is intended to safeguard people from unexpected medical expenditures, went into force on January 1, 2022. But as the federal law indeed reduced high out-of-network health care expenses, as well as some kinds of "balance billing" for the number of provider payments not covered by insurance?

The preliminary assessment of the new law is extremely divided.

Health insurers tout the number of unexpected bills avoided by the law, but they are concerned about the potential weight of claims battles.

Analysts say the law is meant to give significant consumer safeguards, but they haven't seen enough data to gauge compliance.

According to Morning Consult research conducted in June, health care customers assign a poorer rating. According to the research, one out of every five respondents got an unexpected medical expense in the year's first half. But it's unclear how many of those shocks if any, should have been prevented by the No Surprises Act's minimal safeguards.

According to research issued Nov. 17 by AHIP, an insurance industry trade organization, and the Blue Cross Blue Shield Association, the law has avoided more than 9 million possible surprise costs from reaching commercially insured patients.

According to the research, healthcare providers have filed 275,000 claims to a federal arbitration procedure established by the bill to independently adjudicate conflicts between plans and providers – about ten times what the government projected.

While praising the bill's effectiveness in preventing surprise bills thus far, David Merritt, senior vice president of policy and advocacy for the BCBSA, expressed concern in a press release: "The tens of thousands of arbitration claims filed by providers clearly demonstrate that more needs to be done to ensure that they don't abuse the system for their financial gain."

Meanwhile, analysts are waiting to see how successful the measure would be in the long run.

"It's challenging to determine whether the law is actually being implemented because the issue is whether consumers aren't getting surprised bills," says Patricia Kelmar, director of health care campaigns at the United States Public Interest Research Groups, a national federation of consumer advocacy organizations. "It's difficult to quantify an event like a surprise bill since it's not meant to happen in the first place."

Low consumer knowledge of the additional safeguards adds to analysts' skepticism about the law's effectiveness. According to a June Morning Consult research, only 16% of respondents had seen, read, or heard anything about the No Surprises Act. Consumers unaware of the law are also unaware of their rights if providers and insurers fail to comply.

The law's complexities, including provisions that allow out-of-network costs and balance billing in some cases, present further concerns. "The NSA covers not everything that patients perceive to be a surprise cost," says Loren Adler, associate director of the University of Southern California-Brookings Schaeffer Initiative for Health Policy. Urgent care, for example, is not covered by the law's emergency care safeguards.

Is The New Law Effective?

It may be too soon to assess the effectiveness of the new consumer safeguards, and federal agencies are not disclosing numbers. The Centers for Medicare and Medicaid Services, or CMS, and the Department of Health and Human Services did not reply to requests for information on consumer complaints of No Surprises Act breaches.

"It's difficult to say," says Karen Pollitz, senior fellow and co-director of the Program on Patient and Consumer Protections at KFF, a health care news, and policy organization. "If an error is made, it is up to the consumer to figure out what to do next, which is not how it should have worked."

Other commentators are pleased with the overall success of the law. "The No Surprises Act is doing fairly well," adds Adler. "It doesn't solve every problem in the healthcare system, and there are still a few sources of unexpected expenses."

"The law is fantastic, and the administration should keep rolling it out until it is fully implemented," Kelmar adds.

What To Do If You Get A Surprise Bill

What do you think about a provider fee that is much higher than the in-network coverage provided by your plan? You may require assistance in determining the nature of the charge. "This might be an error, or providers could still be trying to benefit from sending a balance charge," Kelmar explains.

It's critical to understand that CMS has two systems in place for customers who dispute provider bills:

•You can file a complaint if you have health insurance and feel you are being charged more than your plan's in-network rate for doctors or services covered under the No Surprises Act.

•You can challenge a bill if you are uninsured or choose not to utilize your insurance and the provider charged more than $400 over their estimate.

Your state picked one way of enforcement under the No Surprises Act:

•Some states handle their own law enforcement.

•Other states delegate enforcement to federal authorities

•Other states work with federal authorities to enforce laws.

The No Surprises Help Desk should be able to answer your questions about how enforcement works in your state.

"If you get an unexpected bill from a provider, your first option is your insurance; they are at risk of losing their license if they don't cooperate," Adler recommends.

Pollitz suggests another route: state consumer assistance programs or other state or federal institutions that assist customers with insurance issues. "Consumers should contact whomever they believe can assist them," she advises.