VIDEO: Insurance companies have weaponized the No Surprises Act, may impact patient care

The No Surprises Act (NSA) was created to protect patients from high cost, surprise medical bills and remove consumers from payment disputes between a provider or healthcare facility and their health insurance plan. But while the act seems like a straight forward policy to most people not involved in healthcare, costs in the U.S. healthcare system can vary greatly depending on the level of a patient's insurance, deductibles, deals negotiated between insurance companies and specific providers, or if a patient is being covered by Medicare, Medicaid or paying cash. Prices in the healthcare supply chain also vary depending on the hospital and deals negotiated with vendors for everything a hospital or clinic uses, from disposables and drugs, to durable equipment and medical devices. 

The NSA has been leveraged by some insurance companies as a way to keep their own costs low by forcing providers to adjudicate unpaid bills or underpaid bills using a cumbersome independent dispute resolutions process. 

"Insurance companies have weaponized the No Surprised Act and I don't think the average person on the street knows. They think they have coverage for radiology services, for emergency services or for anesthesia, but I don't think they have any idea that their insurance plans have taken this law and used it as a battering ram to provider groups they have been in contract with for years to say, hey, under this new law we don't have to pay that much anymore. Sorry, if you don't like it, you can file with the process where there are 80,000 claims log-jammed at the federal level. And that is really what is happening right now." 

While he said insurance companies are losing these challenges about 80% of the time, it is adding a lot of extra work, cost, time and frustration to providers who just want to be paid for the medical services they provide.

"I think the physicians reach a point of frustration between burnout and suicide with all of the factors hitting them, and I am concerned about who is going to care for us," Haines explained. "I hear this level of frustration, and I have been practicing healthcare law for 30 years and I have never heard it this high. So part of my message to the patients is that they are going to have to advocate for the physicians, the hospitals and that service they expect is going to be there."

He explained that the current burnout rate among physicians over constant issues with getting paid amid rising costs and lower reimbursements is causing an issue with the American healthcare system. He said there also is a shortage of physicians that is growing and it will eventually lead to people not being able to get the care they need. 

At the same time, he said health insurance costs are rising fast and insurance companies are reporting record profits. 

"There is plenty of money in the system, it is maybe just being misdirected," Gaines said. "We spend more per capita than any other country on the planet and yet we don't have the outcomes."

Gaines said he tells providers there are still issues with the NSA that need to be worked out, including legal challenges. He details the first major court case challenging the NSA from Texas in the interview. Since then, two more cases have been filed to challenge the rules of the NSA.

The first Texas legal challenge resulted in the judge sending the rule for how the policy is carried out back to the federal agencies for further refinement and clarification. That case will be back in court for review in February 2023.