Rethinking the No Surprises Act: Advocacy Before 2022

Even before the No Surprises Act’s official implementation, a variety of physician organizations have advocated for an improved IDR process, as it favors insurers in its current state. Here are some examples of advocacy from the AAOS and ASA, among others, published before 2022. 


The American Society of Anesthesiologists is concerned about BlueCross BlueShield of North Carolina and its abuse of the NSA. 

In November of 2021, insurers sent letters to physicians, including anesthesiology departments, demanding the physicians accept payment reductions ranging from 10% to over 30%, with the risk of contract termination. Physicians are facing a situation in which they have no chance of winning.

ASA President Randall M. Clark, M.D., FASA, vocalized the following: “Insurance companies are threatening the ability of anesthesiologists to fully staff hospitals and other health care facilities. Left unchecked, actions like these of BlueCross BlueShield of North Carolina will ultimately compromise timely access to care for patients across the country.”


Healthcare providers everywhere are expressing their frustrations with the NSA, demonstrating the importance of pursuing litigation in insurance underpayment disputes.

We commend the American Academy of Orthopaedic Surgeons (AAOS)’s advocacy for physicians and their diligent work to fight back against the IDR process and its disadvantages to providers. As an example, this letter from late 2020 to Congress requested continuous improvements to the legislation, including:

  • Lessening or eliminating the 90-Day waiting period
  • Including an interim Government Accountability Office study to better assess the wait period’s impact
  • Allowing physicians more time to file
  • Excluding public rates from consideration
  • Ensuring a median in-network rate based on all local health plans


In an emergency, can you care for your patients without negatively impacting your practice financially? 

When physicians are forced out of network with low reimbursement rates, the effect reverberates far beyond revenue loss. These repercussions led CMA to write this letter to Congress in July of 2019.

Fewer hospital-based physicians are able to cover their practice costs and respond to emergencies. The danger of limiting patient access to emergency physicians is evident. Other issues also arise, including an increase in medical care services, price gouging in the private sector, Medicare patient copayments, and Medicare spending. 

Unlike the surprise billing law in New York, California’s law did not appropriately incentivize insurers and physicians to enter into contracts to protect physician networks. Additionally, the California dispute resolution process is not working, resulting in a greater need for litigation.

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