Most common No Surprises Act complaints against payers, providers

CMS released a report on Aug. 20 detailing complaints related to No Surprises Act and ACA compliance. 

In total, 16,073 complaints were received. More than 12,000 of the complaints received were related to No Surprises Act compliance. The majority of those complaints — 10,300 — were made against providers, facilities and air ambulance services. The other 1,777 complaints were made against nonfederal governmental plans and issuers.

CMS said 12,700 of the 16,073 complaints have been closed. The agency said that through its investigation process, it directed plans and providers to take remedial and corrective actions, which resulted in $4.18 million in monetary relief paid to consumers or providers. 

Here are the three most common complaints made against providers: 

1. Surprise billing for non-emergency services at an in-network facility - 4,286 complaints 
2. Surprise billing for emergency services - 2,577 complaints 
3. Good-faith estimate - 1,922 complaints 

Here are the three most common complaints made against payers:

1. Noncompliance with qualifying payments amount requirements - 1,035 complaints 
2. Late payment after independent dispute resolution determination - 675 complaints
3. Noncompliance with 30-day initial payment or notice of denial payment requirements - 390 complaints