The federal No Surprises Act may have been a good idea on paper, but it has turned out to be difficult to implement. More than 6 in 10 of 490,000 submitted disputes had not been resolved as of June, according to a new Government Accountability Office report.

The No Surprises Act directed the departments of Health and Human Services, Labor and Treasury to establish a federal independent dispute resolution process. This process, which became effective in April 2022, is a voluntary forum for health care providers and insurers to resolve disputes about how much should be paid for out-of-network care. Certified dispute resolution entities, which serve as arbiters, make payment determinations.

The GAO reviewed published reports, relevant federal laws, regulations and guidance, and interviewed officials from the Centers for Medicare & Medicaid Services and the Labor Department. It also interviewed five selected health care providers or their representatives, which accounted for nearly half of all submitted disputes as of December 2022. In addition, GAO interviewed three issuers, three certified entities that arbitrate the disputes and 10 stakeholder groups.