Insurers May Not Be Ready to Implement No Surprises Act

by Peter Johnson

Health insurers are struggling to comply with the price and billing transparency requirements of the No Surprises Act (NSA), according to a survey conducted by Change Healthcare, Inc. Meanwhile, insurers are lining up behind the Biden administration as it prepares to defend regulations implementing the NSA from a legal challenge brought by provider trade groups. 

Most payers aren’t prepared to meet the NSA’s requirements 

Between August and September last year, Change Healthcare gathered “over 100 responses…from payers across the country” in response to its survey on the NSA. Notable findings included: 

• Nearly 3 out of 4 respondents anticipated difficulty generating Advance Explanations of Benefits (AEOB), which estimate the cost of procedures. 
• More than 6 in 10 respondents said that building and launching price comparison tools would be difficult. 
• Nearly 6 in 10 said the same when it comes to creating Qualified Payment Amounts (QPAs), a metric that is largely based on median in-network reimbursement rates and is one of several factors that arbitrators must consider when deciding a balance billing dispute.  
• 62% of payers didn’t know what kind of AEOB delivery option they would use to reach plan members. 
• The same was true for the provider-facing back end of AEOBs: 69% of health insurer respondents didn’t know how they would receive AEOB requests from providers. 

Trade groups say rule contradicts Congress 

• Meanwhile, insurers have joined the Biden administration’s efforts to fight off lawsuits from provider groups targeting an Oct. 7 interim final rule (IFR) implementing the NSA. 
• The Blue Cross Blue Shield Association (BCBSA) filed an amicus brief in a lawsuit brought by the Texas Medical Association (TMA) seeking to overturn the IFR. AHIP also filed a similar brief in the same case. 
• In another suit brought by the American Medical Association and American Hospital Association, providers argue that the IFR’s guidance to the arbitrators who will decide balance billing disputes “deviates from Congress’s balanced design.” 
• Loren Adler, a health care economist and associate director of the USC-Brookings Schaeffer Initiative for Health Policy, tells AIS that he’s working on an amicus brief for Brookings backing the administration’s rulemaking. 
• “It walks through why the interim final rules are clearly, I think, consistent with the outcomes that Congress was seeking to obtain,” Adler explains. 
• Providers are “going to keep on contesting, trying to get a more generous price support out of the process, even though I think Congress was pretty clear that part of the intent was not to increase prices, and in fact lower some prices. But obviously, provider groups would like that not to be the case, since lower prices come out of their pockets.” 

From Health Plan Weekly