HR 4710, the No Surprises Act Enforcement Act, would authorize penalties on any party that does not adhere to statutory timelines for payment after an IDR entity has made a final and binding determination. This bill is responding to the countless reports MSSNY has received from physician that health insurers are refusing to make payment despite an IDR determination in the physician’s favor. This means that physician practices are forced to absorb unpaid costs, finance delays, and shoulder uncertainty while insurers retain funds they are legally obligated to pay.
MSSNY has joined on to an AMA-initiated federation letter to House and Senate leaders in support of HR 4710.
Unfortunately, some legislators are seeking to move in an entirely opposite direction. As noted in a statement this week from several specialty societies, HR 10788 would remove a critical independent safeguard against unreasonably low insurer payments while rewarding the very insurance company practices that have contributed to problems with the law’s implementation. Of greatest concern is the significant adverse impact that this legislation would have on needed on-call specialty care relied upon by community hospital emergency departments across the state, particularly in underserved areas.
Giving health insurance companies even greater control over physician payments is not the solution to concerns about the IDR process – particularly where data shows that health insurers’ own practices are contributing to the problems Congress should be addressing. The specialty society statement notes that federal IDR data has shown that insurers failed to participate and lost by default on nearly 25% of IDR line items in 2025, as well as submitting offers of $1 or less on additional 8% of line items. Moreover, nearly 40% of insurer offers were at or below the QPA, excluding defaults.
We are expecting discussions on these various legislative proposals to pick up post-election when Congress has a “lame duck” Session to enact an end-of-year spending package.
