Insurers are flouting the No Surprises Act’s IDR process—here is how the new Enforcement Act will penalize bad actors and help providers secure fair reimbursement.
Legal Context
Congress passed the No Surprises Act (NSA) back in 2020, with the goal of protecting patients from unexpected out-of-network medical bills. Concurrently, the goal was also to ensure that healthcare practitioners receive fair, timely compensation for the services rendered.
Broken System
Data show that patients are largely being protected from these bills because of the legislation; however, there is a quagmire of back-and-forth between health plans and practitioners. The dispute system is plagued with delays and noncompliance.
The dispute system, an Independent Dispute Resolution (IDR) process, was created by the NSA. The design of the IDR provided appropriate timelines and binding arbitration determinations for out-of-network services; however, the mandates of the process aren’t being followed by all insurers.
At Kovo RCM, we see these challenges daily as we help our clients fight for fair reimbursement through IDR. Emergency department providers, air ambulances, and anesthesiologists are seeing continued noncompliance from insurers. Even when a physician clearly wins an IDR case, insurers are either refusing to pay or dragging out the payment disbursement far past the 30-day timeframe.Data from the Emergency Department Practice Management Association (EDPMA) show that nearly a quarter of emergency department practices that submitted claims through IDR in 2024 were left unpaid, underpaid, or with significant payment delay.
Impetus For New Legislation
The American Medical Association (AMA) and scores of medical societies raised their voices to call foul, as it became recognized that there aren’t strong enough enforcement mechanisms and consequences for insurers that flout the rules of the IDR process. Physicians and healthcare organizations have reached out to Congress and federal regulators demanding intervention.The May 11th, 2026 letter sent to Congress by AMA and over 50 other supporting organizations can be found here.
Facts About the New Legislation
Bipartisan legislation has been introduced in 2026 in both the House and the Senate with a bill called the No Surprises Act Enforcement Act (H.R. 4710/S. 2420).
Key facts about the proposed legislation:
- Strict Penalties: The bill explicitly authorizes financial penalties for any party that fails to meet the statutory payment deadlines after a final, binding IDR decision is made.
- Empowered Regulators: It grants federal regulators the explicit authority needed to aggressively enforce these IDR decisions, ensuring that health plans can no longer ignore the outcomes of arbitration.
- Massive Industry Support: The bill is backed by a massive coalition of healthcare advocates. In a recent letter to congressional leaders, the American Medical Association (AMA), 50 state medical societies, and 46 other healthcare groups voiced their strong support for the legislation.
Looking Ahead
Protecting patients from surprise billing was a massive step forward for American healthcare, but the system cannot function if the doctors providing the care are systematically denied their rightful payments. By establishing real penalties and empowering regulators, the No Surprises Act Enforcement Act aims to finally deliver the balanced, fair system that was promised back in 2020.
Need Help Navigating IDR?
Kovo RCM has a wealth of experience with this process and a dedicated team that specializes in IDR for out-of-network anesthesia practitioners, air ambulance providers, and emergency department physicians. Call us to discuss how we may be a partner for you!