ACR Supports New Bill to Penalize Insurers for Delayed Payments

The American College of Radiology® (ACR®), American College of Emergency Physicians (ACEP) and the American Society of Anesthesiologists (ASA) strongly support H.R.4710 / S. 2420, the No Surprises Enforcement Act,  introduced yesterday that will fine health insurance companies that fail to pay physicians within 30 days after losing the independent dispute resolution (IDR) 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 IDR process. If the independent arbiter rules in favor of the physician, by law, the insurer must pay the physician within 30 days. Reports of insurers failing to timely pay these arbitration awards are commonplace.

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

“Insurance companies taking advantage of flaws in the NSA system jeopardizes the sustainability of anesthesia practices, threatening access to care,” said ASA President Donald E. Arnold, MD, FACHE, FASA. “This legislation would hold big insurance companies accountable and shows a continued bipartisan interest in improving the No Surprises Act system.”

H.R. (4710) and its Senate companion S. Y2420 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. The House legislation was introduced by Rep. Greg Murphy, MD, Rep. Jimmy Panetta, Rep. John Joyce, Rep. Kim Schrier, MD, Rep. Bob Onder and Rep. Raul Ruiz, MD. The Senate companion was introduced by Sen. Roger Marshall and Sen. Michael Bennett.

“Insurance companies must be held accountable to reimburse providers for the amount determined by the IDR process,” said Alan Matsumoto, MD, FACR, chair of the ACR Board of Chancellors. “Now, insurers are often not paying at all for these services provided to patients. This refusal trend may threaten the ability of practices to provide services in their communities and restrict patient access to care that the NSA was supposed to protect.”

“This bipartisan bill takes critical steps to stop insurer bad practices,” said Alison Haddock, MD, FACEP, president of ACEP. “The games insurers play have real consequences for physicians and patients, especially in rural and underserved communities. ACEP strongly applauds the introduction of this legislation and urges its prompt passage to make sure that insurance companies are not given a free pass to skirt the law and avoid their payment obligations."

ACR, ACEP 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.

ACR supports the No Surprises Enforcement Act to fine insurers that do not pay physicians within 30 days after losing independent dispute resolution.