Medical Front-Liners Report Ongoing Insurer Abuse

NSA Impact Analysis Reveals Alarming Findings Across the U.S.

WASHINGTON, Oct. 9, 2024 /PRNewswire/ — Americans for Fair Health Care (AFHC), a leading coalition dedicated to advocating for fair health insurance practices, has released its second annual No Surprises Act (NSA) Impact Analysis. Representing 50,000 physicians and advanced practice clinicians, AFHC conducted the NSA Impact Analysis to assess the experience of physicians and advanced practice clinicians in 2023. Key survey results include the following:

Insurers Are Continuing to Reduce Patient Access to In-Network Care by Canceling Provider Contracts: In 2023, 53% of providers were threatened with contract termination and nearly a quarter of respondents suffering a termination. Additionally, insurers made unilateral contract amendments 24% of the time and made take-it-or-leave demands at the average rate of 4 times per provider.

Insurers Are Continuing to Significantly Reduce and/or Delay Payments to Providers: In 2023, insurers slashed payments by an average of 51% following contract terminations. The survey also found that a staggering 94% of medical practices received Qualifying Payment Amounts (QPAs) at or below Medicare rates and that insurers failed to pay 22% of the payments determined by Independent Dispute Resolution Entities (IDREs). Insurers also failed to make 35% of payments within the required 30 days and issued incorrect payments 19% of the time.

Insurers Are Continuing to Obstruct the Resolution Mechanisms Established by Congress: Insurers resolved disputes in only 7% of Open Negotiations in 2023 and provided counteroffers only 29% of the time during Open Negotiations. Additionally, disclosure of federal IDR-eligible claims was made only 43% of the time and dispute resolutions also took an average of 88 days to complete 

Insurers Are Continuing to Engage in Other Serious Violations of NSA Noncompliance: Insurers rejected IDRE determinations 121 times and increased patient cost sharing following IDR determinations 4,899 times in 2023. Further, 87.5% of providers experienced denial of NSA-covered services 5,024 times last year. 

“The NSA Impact Analysis underscores the urgent need for action,” stated Eric Berger, AFHC Executive Director. “Insurers’ persistent contract terminations, payment cuts and delays, patient burdens, and compliance failures are forcing physicians to seek fair treatment through the IDR process. Insurers’ ongoing abuse highlights the need for targeted action to ensure the NSA’s protections are fully realized and that patients receive the in-network care they deserve.”

For further information and to support efforts for fair healthcare practices, visit www.americansforfairhealthcare.org.

CONTACT
McHenry Lee
[email protected]

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SOURCE Americans for Fair Health Care (AFHC)