No Surprises Enforcement Act

The No Surprises Enforcement Act is a bill introduced in both the United States House of Representatives and Senate as an additional layer to the No Surprises Act, which seeks to protect patients against unexpected medical costs from out-of-pocket care. The bill is a bipartisan initiative: its sponsors in the House are Representatives Greg Murphy (R-NC), Jimmy Panetta (D-CA), John Joyce, (R-PA), Raul Ruiz (D-CA), Bob Onder (R-MO), and Kim Schrier (D-WA), and Senators Roger Marshall (R-KS) and Michael Bennet (D-CO) have introduced companion legislation.1

A surprise medical bill is one issued for emergency care administered by an out-of-network provider or in other situations in which a patient unexpectedly receives out-of-network care. If one’s health insurance does not cover the full cost of out-of-network care, they could be subject to balance billing, in which the patient pays the difference of the total cost of care and what their plan covers—on top of any co-payments or payments towards a deductible they might owe. Patients might not know they received out-of-network care until they are billed.2

The No Surprises Act, passed into law as part of the Consolidated Appropriations Act of 2021 and effective as of January 1, 2022, protects patients from balance billing for out-of-network care for most emergency services and some non-emergency services. Patients cannot be billed more than what they would pay an in-network provider for these services.3 The Act also requires providers to give uninsured patients a “good faith estimate” of how much care will cost before administering care. Finally, the Act established an independent dispute resolution (IDR) process for providers and health plans at odds over how much each party will pay.3

The Act has led to successes: according to a survey from the America’s Health Insurance Plans and the Blue Cross Blue Shield Association, it has protected Americans from over 10 million surprise medical bills.4 But it is in large part due to the IDR process, or the failure thereof, that members of Congress have introduced the No Surprises Enforcement Act. A 2024 survey by the Emergency Department Practice Management Association found that, in 24% of cases where IDR disputes resulted in health plans owing payments to providers, the payments were either not disbursed or were disbursed incorrectly within 30 business days, as required by the Act.5

The No Surprises Enforcement Act builds upon the earlier No Suprises Act to compel insurers to pay the right amounts in a timely fashion. The Enforcement Act increases penalties for health plans that are practicing balance billing.6 For insurers that are not paying what they owe, the Enforcement Act would impose a penalty up to three times the difference between the insurer’s initial payment and the amount the IDR has determined is owed.7 Finally, in an effort to increase transparency, the Enforcement Act also establishes a more rigorous system of requirements for reporting which health plans were audited for potential violations. Although the Enforcement Act will need to be approved by both the House and Senate and signed by the president before becoming law, the broad support that exists for the measure provides it a decent likelihood of passage.

References

  1. Murphy Introduces Bipartisan, Bicameral Legislation to Improve Enforcement of No Surprises Act | Congressman Greg Murphy. http://murphy.house.gov/media/press-releases/murphy-introduces-bipartisan-bicameral-legislation-improve-enforcement-no (2025).
  2. What is a “surprise medical bill” and what should I know about the No Surprises Act? Consumer Financial Protection Bureau https://www.consumerfinance.gov/ask-cfpb/what-is-a-surprise-medical-bill-and-what-should-i-know-about-the-no-surprises-act-en-2123/ (2023).
  3. Pollitz, Karen. No Surprises Act Implementation: What to Expect in 2022. KFF https://www.kff.org/affordable-care-act/no-surprises-act-implementation-what-to-expect-in-2022/ (2021).
  4. No Surprises Act Continues to Prevent More than 1 Million Surprise…. AHIP https://www.ahip.org/resources/no-surprises-act-continues-to-prevent-more-than-1-million-surprise-bills-per-month-while-provider-networks-grow.
  5. Robertson, Adam. EDPMA survey reports that emergency medicine physician groups experience a 39% reduction in out-of-network reimbursement since the implementation of the No Surprises Act. EDPMA | Emergency Department Practice Management Association https://edpma.org/edpma-survey-reports-that-emergency-medicine-physician-groups-experience-a-39-reduction-in-out-of-network-reimbursement-since-the-implementation-of-the-no-surprises-act/ (2024).
  6. Sen. Marshall, R. [R-K. Text – S.2420 – 119th Congress (2025-2026): No Surprises Act Enforcement Act. https://www.congress.gov/bill/119th-congress/senate-bill/2420/text (2025).
  7. No Surprises Enforcement Act receives support from American College of Radiology | Healthcare Finance News. http://www.healthcarefinancenews.com/news/no-surprises-enforcement-act-receives-support-american-college-radiology (2025).