The Coalition Against Surprise Medical Billing has launched a public campaign opposing the No Surprises Act Enforcement Act, contending that the proposed legislation would amplify abuse within the independent dispute resolution (IDR) process.

The No Surprises Act, enacted in 2022, prohibits health care providers and insurers from billing patients for out-of-network emergency services or certain non-emergency care at in-network facilities beyond their cost-sharing obligations. When providers and insurers cannot agree on payment rates, the law directs them to independent dispute resolution, where a neutral arbitrator determines the appropriate reimbursement.

The Coalition's opposition focuses on the enforcement bill's potential to exacerbate existing IDR vulnerabilities. The coalition argues that strengthening enforcement mechanisms without addressing systemic flaws in the dispute resolution framework would incentivize gaming behavior by both providers and insurers, ultimately harming patients and destabilizing the health care payment system.

IDR has faced documented challenges since implementation. Arbitrators have reported pressure from repeat participants, inconsistent application of benchmarking methodologies, and strategic filing patterns designed to influence outcomes rather than resolve genuine payment disputes fairly.

The Coalition's campaign targets policymakers at both federal and state levels. The group contends that any enforcement enhancement should include guardrails against IDR abuse, such as clearer standards for arbitrator selection, more transparent benchmarking criteria, and penalties for frivolous dispute filings.

This opposition reflects broader tensions within health care policy circles. Provider organizations and some insurers support stronger enforcement to prevent non-compliance with the No Surprises Act's core protections. Patient advocates and some state regulators share the Coalition's concern that enforcement without reform could create perverse incentives that ultimately increase surprise billing incidents.

The dispute underscores a fundamental challenge in health care regulation: balancing enforcement intensity against unintended consequences. As the No