ACEP Strongly Supports New Legislation that Penalizes Insurers for Delayed Payments

WASHINGTON, D.C. - The American College of Emergency Physicians (ACEP), American College of Radiology^® (ACR^®), and the American Society of Anesthesiologists (ASA) strongly support legislation introduced recently that will fine health insurance companies that fail to pay physicians within 30 days after losing the independent dispute resolution process laid out in the No Surprises Act (NSA).

This legislation does not impact the important patient protections included in the NSA that ACR^®, ACEP and ASA advocated for and continue to fully support, nor does it raise patient out-of-pocket costs.

The NSA requires insurers to promptly pay physicians. If a physician or a practice considers the payment offered by the insurer to be inadequate, they can challenge the payment by using the NSA's independent dispute resolution (IDR) process. If the independent arbiter rules in favor of the physician, by law the insurer must pay the physician the award amount within 30 days. Reports of insurers failing to pay these arbitration awards in a timely manner are commonplace.

According to government data, insurance companies lose nearly eight out of 10 IDR cases to physicians or other providers.

"With this bill, big insurance companies that have been gaming the No Surprises Act system will be held accountable," said ASA President Ronald L. Harter, M.D., FASA. "Insurers are required to make a payment after they lose in the IDR process within 30 days, which they have failed to do in many cases. This jeopardizes the sustainability of anesthesia practices, particularly small and medium sized community-based practices, and threatens the public's access to health care."

HR 9572 will impose a penalty three times the difference between the insurer's initial payment and the IDR entities ruling per claim. The claim will also be subject to interest.

"There is a real need for accountability after disputes are resolved under the No Surprises Act, because right now insurance companies are often just not paying," said Alan Matsumoto, M.D., FACR, chair, American College of Radiology Board of Chancellors. "This situation may leave clinicians in financial peril, which in turn threatens the access to care for patients that the No Surprises Act was supposed to protect. The ACR supports this legislation and its sponsors' continued work to protect the principles of the No Surprises Act.""Insurers have a long track record of doing all they can to skirt their legal obligations to provide fair and timely reimbursement," said Aisha Terry, M.D., MPH, FACEP, president of the ACEP. "This bill holds insurers accountable for prompt payment, halts unscrupulous tactics, and will allow emergency physicians to focus on treating patients and saving lives."

ACEP, ACR, and ASA urge Congress to pass this bill to ensure insurance companies pay physicians and their practices fairly and in a timely manner, so they may continue to care for their patients.

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