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- Physician groups urge stronger enforcement of No Surprises Act protections
On April 27, the CAP joined the American Medical Association and dozens of national specialty and state medical societies in a letter urging the Departments of Treasury, Labor, and Health and Human Services to strengthen enforcement of the No Surprises Act (NSA).
The concern: Physician groups report that some health plans are exploiting gaps in the independent dispute resolution (IDR) process, shifting costs to patients and destabilizing physician practices.
What’s happening:
- Some plans increase patient cost sharing even after an IDR decision in the physician’s favor.
- Plans are reopening settled IDR cases and delaying payment.
- IDR awards are being paid late, underpaid, or unpaid.
- Plans do not disclose how qualified payment amounts are calculated.
The impact: These practices undermine the NSA’s intent to protect patients from surprise bills and ensure fair physician payment. Persistent payment delays and shortfalls threaten independent practices and patient access to care.
What we’re asking: The letter calls on federal agencies to increase enforcement, improve transparency across the IDR process, and hold health plans accountable for following the law as intended.