The No Surprises Act (NSA), which took effect January 1, 2022, shields patients from unexpected bills when they receive emergency care from out-of-network providers or non-emergency care at in-network facilities where they had no choice. It also prohibits balance billing for those services and establishes a dispute resolution process between insurers and providers. For employers, the law’s cost impact is more complicated. It was designed to remove some of the most inflated charges from the system. Whether it lowers, raises, or simply redistributes employer costs depends on how the new rules interact with provider negotiations, plan design, and the broader forces that drive healthcare spending.
What the No Surprises Act does
The NSA applies to most private group and individual health plans. Its core protections include: banning balance bills for emergency services regardless of where they are delivered, even at out-of-network facilities; banning out-of-network cost-sharing above in-network levels for those visits; and requiring that patients receive a plain-language explanation of their benefits and rights. When providers and insurers cannot agree on payment for an out-of-network service covered by the law, they enter a federal Independent Dispute Resolution (IDR) process. An arbiter picks one side’s offer based on factors including the median in-network rate, provider training and experience, and market share.
How it affects employer plan costs
The Congressional Budget Office estimated in 2020 that the law would reduce private health insurance premiums by an average of 0.5 to 1 percent. The theory was straightforward: if providers can no longer collect balance bills from patients at out-of-network rates, the system would shed a layer of inflated charges, and that savings would flow through to premiums. In practice, the early data is less clear.
Where costs could come down
Some employers saw a near-term drop in out-of-network spending simply because the law removed the incentive for certain specialties-emergency medicine groups, anesthesiology practices, and ambulance services-to remain out of network and bill patients at premium rates. A 2023 survey of 25 large employers by the Business Group on Health found that most reported no significant increase in health plan costs tied to the NSA, and several noted that surprise billing protections had helped avoid catastrophic claims for employees. For self-funded employers, especially those who had already been auditing outlier claims, the NSA added another layer of negotiating leverage.
Where costs could go up
The IDR process was meant to resolve about 17,000 payment disputes per year. By mid-2023, the Centers for Medicare and Medicaid Services reported that over 330,000 disputes had been filed-roughly 13 times the initial estimate. The sheer volume forced administrative fees up, and those costs get passed to plans in the form of per-claim surcharges. More important, some providers use the threat of IDR arbitrations to push in-network reimbursement rates higher during contract negotiations. If a hospital-based physician group knows it can take a payment dispute to an arbiter who considers total charges alongside median contracted rates, it may anchor its ask above what the plan would normally pay. Those increases then ripple through premiums for the following plan year.
The compliance burden
Employers that sponsor group health plans must ensure their carriers or third-party administrators are following the NSA’s notice requirements and processing claims correctly. In a fully insured arrangement, the carrier shoulders most of that load. For self-funded plans, the employer (as plan administrator) carries the fiduciary responsibility, even if a TPA handles the day-to-day. Several law firms that advise employers have flagged the need for updated service agreements and audit protocols. The cost of that legal and administrative work is real, though typically a fraction of the total claims spend.
Structural cost drivers remain unchanged
The No Surprises Act addresses a symptom-the surprise bill-but leaves the underlying cost disease intact. The middleman problem, where pharmacy benefit managers and insurers take a cut at every step, churns on. A hospital bill still reflects marked-up charges negotiated in a system where the largest players have the most pricing power. About one in three Americans still skip care because of what it might cost them out of pocket. Medical debt remains the leading cause of personal bankruptcy in the United States. Removing the surprise from a bill does not remove the pricing opacity that created it in the first place.
Moving from protection to prevention
Employers who want to control healthcare costs over the long term can pair regulatory protections like the NSA with a structural shift toward prevention and aligned incentives. That is the design of the WellthCare™ system. When employees have access to $0-co-pay care through a WellthCare Plan-used first, alongside existing major medical coverage-fewer claims reach the primary plan. Employees get their annual physicals, preventive screenings, and urgent care visits without a deductible or surprise bill, because WellthCare's network and plan design remove those friction points. The employer sees fewer high-cost claims and a healthier, more engaged workforce.
WellthCare does not simply react to billing disputes after they happen. It builds a system where verified preventive actions earn real, spendable dollars at the WellthCare Store and seed automatic retirement contributions over time. That creates a compounding loop: employees use more preventive care, chronic issues get caught earlier, and the downstream claims that drive premium increases shrink. The No Surprises Act protects patients when the system fails. A Health-to-Wealth™ approach changes the incentive structure so the system fails less often.
The NSA is an important federal safeguard. But no regulation can fully insulate an employer from a healthcare market that is overpriced by design. A WellthCare Plan gives employers a proactive way to put downward pressure on costs while giving employees something they will actually use and value. Ask your broker how a zero-net-cost WellthCare Plan could fit alongside your current medical coverage-and whether your team is ready for a benefits system that pays them back.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors for guidance specific to their plan.