It's been over a year since the U.S. government's No Surprises Act, legislation seeking to prevent surprise medical bills, came into effect.
The act was passed in August 2021 and has become a subject of controversy for providers and payers across the U.S., with concerns relating to increased emergency room visits, increased regulatory burdens and out-of-network payer disputes.
Currently, some providers feel they are on an uneven playing field when it comes to reimbursement from insurance organizations under the new legislation.
Adam Spiegel, CEO of NorthStar Anesthesia, told Becker's the field of anesthesiology is not immune to these concerns.
Mr. Spiegel explained the difficulty of navigating provider-payer relationships within the new act, specifically in anesthesia. He said that while most providers are able to reach a fair and reasonable agreement with payer groups, anesthesia providers do not have that option.
"I support the No Surprises Act and its goals to protect patients from surprise medical bills. I also want to ensure that its implementation works well for everyone," Mr. Spiegel said.
He described how payers will no longer negotiate with anesthesia providers for fair rates after the implementation of the new rules.
Instead, with the new act, anesthesia providers are forced to take reduced fees or face being dropped from payer contracts, after which they will be paid the qualifying payment amount, which is typically much lower than typical contracted rates.
In order to rectify these disputes, providers and payers are required to go through the federal independent dispute resolution process, Mr. Spiegel said, which has been criticized for being more favorable to payers.
"I think they assumed that they'd get something like 4,000 IDR requests across the year, and they've gotten like 90,000 in the first six months," Mr. Spiegel said.