CMS closes thousands of No Surprises Act complaints, directs $4M in relief

By Noah Tong / August 21, 2024

The Centers for Medicare & Medicaid Services (CMS) issued a new report Tuesday detailing total complaints related to the No Surprises Act and Affordable Care Act compliance.

Providers and consumers earned $4.18 million in relief after the agency received more than 16,000 complaints, as of June 30. More than 12,000 complaints were tied to the No Surprises Act compliance, while 248 were about Affordable Care Act compliance. About 3,000 cases are still open.

Of the No Surprises Act complaints, 10,300 were against providers, facilities and air ambulance services. Just 1,777 complaints were made non-federal governmental plans and issuers. Approximately 35% of closed cases found no violation.

Most complaints against providers and air ambulance services were regarding surprise billing for non-emergency services at an in-network facility, followed by surprise billing for emergency services and good faith estimates.

Against plans and issuers, CMS said non-compliance with qualifying payment amount requirements was the most cited complaint.

The report marks a slight increase from CMS’ findings in May, where the agency said it had received 14,324 complaints and issued $3.46 million in relief to consumers and providers.

The No Surprises Act is a federal law aimed at ensuring patients do not get charged exorbitant medical fees when receiving emergency out-of-network care. The law created an independent dispute resolution process for disputes between health plans and providers to solve the most complicated claims.