Surprise medical bills occur when a patient receives out-of-network care in situations largely outside their control — for example, emergency care or procedures performed by an out-of-network specialist at an in-network facility. Patients receive a surprise bill from their insurer for the balance between the provider’s charge and the insurer’s allowed rate. The No Surprises Act banned this practice, effective January 2022.

Erin Duffy, PhD, a research scientist at the USC Schaeffer Center has published a study leveraging data from Texas — which banned surprise bills and implemented a dispute resolution process in 2020 — that has found that arbitration outcomes in the state, which implemented a dispute resolution system in 2020, were largely anchored to the established median in-network allowed amount, rather than a much higher alternative benchmark set at the 80% of charges. The study was published earlier this month in the Journal of the American Medical Association.

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