Insurers and health plans may have slashed payments to some types of physicians during the first years that the federal No Surprises Act was in effect.
The law is supposed to protect insured patients from getting big, unexpected, out-of-network bills. The act was signed into law in December 2020 and took effect Jan. 1, 2022.
Commercial payers' "allowed amounts" for emergency room facilities increased 5.8% between 2019 and 2021, and then increased another 6.1% between 2021 and 2023, according to the U.S. Government Accountability Office.
For anesthesiologists, the allowed amounts fell about 4% during the two years before the No Surprises Act took effect, and then fell another 7% between 2019 and 2021.
For emergency room doctors, average allowed amounts fell 9% during the two years before the act took effect, then fell another 12% during the two years after the act took effect.
ER doctors' average charges dropped to $336 in 2023, down from $383 in 2021.
What it means: The GAO pay data could explain why ER doctors sound so unhappy.
The No Surprises Act: Congress enacted the No Surprises Act in an effort to protect patients with health coverage from getting big, unexpected, out-of-network bills for certain types of services.
The services are emergency room care, services provided by out-of-network doctors at in-network hospitals, and air ambulance services.
The affected payers and health care providers are supposed to take disputes over out-of-network claims to an"independent dispute resolution" system.
Both payers and providers have argued that the No Surprises Act IDR process is unfair.
Payers have sued providers over No Surprises Act disputes, and providers have sued insurers, health plans and plan administrators over disputes related to the act.
The U.S. Government Accountability Office report: The GAO is an arm of Congress that helps members of Congress keep tabs on the rest of the federal government.
GAO investigators audited the impact of the No Surprises Act by looking at commercial coverage claim data compiled by Komodo Research.
The data set included health claim data for 110 million people with commercial health coverage.
The people in the data had coverage from self-insured employer health plans, fully insured employer health plans, or individual or family health insurance policies.
In-network vs. out-of-network: More than 95% of the ER, anesthesiology and radiology claims patients filed in 2019 and 2020 were in-network claims.
The percentage of claims filed as in-network claims increased from 2021 to 2023.
Data concerns: The GAO analysts noted that the claim data is incomplete and does not include the biggest payer in every state.
Another weakness is that the "allowed amounts" used include the amounts that the insurers and plans were supposed to pay and the amounts that the patients were supposed to pay out of their own pockets.
A health care finance firm, iVitaFinancial, has estimated that patients are now responsible for an average of about 30% of the typical medical bill and that collecting any "patient financial responsibility" amounts can be difficult.
If hospitals are having a more difficult time collecting cash from patients than physicians are, that could explain part or all of the difference between patient allowed amount trends and hospital allowed amount trends.
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