Surprise medical bills are down. But could the system be driving up healthcare costs?

The federal No Surprises Act has been a win for consumers in one important way: It has reduced the number of surprise medical bills for people who unknowingly receive care from providers outside of their health insurance network.

But new reporting suggests the law’s payment dispute system may increase payments for some out-of-network care, and those higher costs can eventually contribute to higher premiums and out-of-pocket costs.

A recent New York Times investigation found that some physician practices have increasingly used the law’s independent dispute resolution process to seek higher payments for out-of-network care and throw this process frequently receiving amounts well above typical negotiated rates.

For example, New York Times reporters found one plastic surgeon practicing in New York and Florida, who sometimes earns $440,000 for a breast reduction surgery that normally costs $15,000 to $25,000.

That’s possible because the data shows that providers – doctors, hospitals and others – typically prevail in 85% of all disputed cases.

The New York Times continues digging into what this means for consumers. For example, in another story, reporters found surgical assistants are exploiting loopholes in the law and the arbitration process. One highlighted case showed a surgical technician in Dallas earning $50,456 for assisting with a prostate removal operation while the surgeon, who accepted the patient’s insurance, earned $1,843.

Those findings have also caught the attention of the Congressional Budget Office. In a recent analysis, reported by Healthcare Dive, the Budget Office said emerging evidence suggests the No Surprises Act may not have all the effects originally expected and called for additional research into whether the arbitration process is contributing to higher medical prices and insurance premiums over time.

Importantly, the federal law continues to protect patients from surprise medical bills. The debate now centers on how healthcare providers and health plans resolve payment disputes behind the scenes—and whether the arbitration process can be improved without increasing costs for consumers.

 What do you think? Have you benefited from the No Surprises Act or experienced surprise medical bills before the law took effect? Share your story with Voices for Affordable Health.