Overview of Selected No Surprises Act Litigation (CRS Report for Congress)
| Release Date |
Sept. 7, 2023 |
| Report Number |
LSB11036 |
| Report Type |
Legal Sidebar |
| Authors |
Wen W. Shen |
| Source Agency |
Congressional Research Service |
Summary:
The No Surprises Act (NSA), part of the Consolidated Appropriations Act, 2021 (P.L. 116-260),
established various consumer protections related to surprise billing i.e., circumstances where individuals
receive large, unexpected medical bills when they are unknowingly, and potentially unavoidably, treated
by out-of-network providers. In those situations, the NSA generally limits the amount consumers pay for
care and specifies a methodology used to determine how much insurers must pay providers for care.
Under the federal payment methodology, when an insurer and an out-of-network provider cannot agree on
the relevant payment amount, either party may initiate an independent dispute resolution (IDR) process
before a private arbitrator, or an IDR entity, who would select between the parties payment offers after
considering a list of statutory factors. This process effectively results in the provider and insurer
recognizing the same total price for care.
