The No Surprises Act: Relief for Patients, Pressure for Providers?

The No Surprises Act (NSA) has brought long-overdue protections for patients—particularly in ACA and commercial markets—by limiting surprise balance billing. While this is a clear win for consumers, it has also shifted financial burdens elsewhere in the healthcare system.

A Shift in Reimbursement Strategy

We’re now seeing “usual and customary” (U&C) rates replace the previously common percentage-of-charge methodology for out-of-network (OON) claims. The outcome? U&C payments are typically much lower—ultimately favoring payers over providers.

Though patients benefit from being shielded from unexpected bills, the ripple effect on provider cash flow, operational complexity, and administrative overhead is significant.

Is the System Creating a New Cash Flow Model?

The question we must ask is:

Are these regulations inadvertently creating opportunities for payers to optimize cash flow—at the expense of provider reimbursement and system efficiency?

Here’s how:

• Providers may be forced to accept lower payments or enter costly arbitration.

• Some payers proactively pursue out-of-network agreements to minimize care disruption and avoid the administrative burden of single case agreements (SCAs).

• Others delay reimbursement or issue post-service SCAs, adding to provider cash flow strain.

This isn’t just a financial conversation—it’s about sustainability. As more providers struggle to manage below-market reimbursements, long arbitration timelines, and uncompensated administrative costs, the question becomes:

How do we evolve beyond the outdated and burdensome SCA process?

🧮 How TotalMed Networks Helps

At TotalMed Networks, we work with providers and health systems to overcome these challenges with smart, data-driven strategies that improve financial resilience.

We offer: 

 ✅ Provider contracting services

 ✅ A/R optimization and cash flow consulting

 ✅ Alignment strategies between payers and providers

Our mission is to help physicians, clinics, and provider networks navigate payer relationships more effectively—unlocking better outcomes, streamlined operations, and sustainable care delivery.

🔗 Learn more at: www.totalmednetworks.com

🛡️ Legal Note:

This post is for informational purposes only and does not constitute legal or financial advice.

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