Private health insurance: Roll out of independent dispute resolution process for out-of-network claims has been challenging : report to congressional committees
- Collection:
- Health Policy and Services Research
- Alternate Title(s):
- Roll out of independent dispute resolution process for out-of-network claims has been challenging: report to congressional committees
- Contributor(s):
- United States. Government Accountability Office, issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, December 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Dissent and Disputes Government Regulation Health Benefit Plans, Employee Health Expenditures Insurance Claim Review Insurance, Health, Reimbursement Negotiating United States
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. About two thirds of individuals in the United States receive their health coverage through private health plans. Balance billing is when insured patients receive a bill from a health care provider for the difference between the amount charged and the payment received from the health insurance issuer. An unexpected balance bill is referred to as a “surprise bill” and may create a financial strain for patients. For individuals with private health insurance, the No Surprises Act prohibits providers from balance billing in certain circumstances and directed the three departments to establish the federal independent dispute resolution process. The Consolidated Appropriations Act, 2021, includes a provision for GAO to review the federal independent dispute resolution process. This report describes (1) the number and types of disputes submitted between April 2022 and June 2023, and the status of their resolution; (2) selected stakeholders’ experiences with the process, and agency actions to address challenges; and (3) how federal agencies oversee the process. GAO reviewed published reports, relevant federal laws, regulations, and guidance; and interviewed officials from CMS and Labor. GAO also interviewed five selected health care providers or their representatives, which accounted for nearly half of all submitted disputes as of December 2022. In addition, GAO interviewed three issuers, three certified entities that arbitrate the disputes, and 10 stakeholder groups.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (ii, 46 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918750688406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918750688406676