Published 12/18/2020

AAOS Encourages Congress to Improve Deal to End Surprise Medical Billing

Washington, D.C. (December 17, 2020)The American Association of Orthopaedic Surgeons (AAOS) is asking Congress to improve the “No Surprises Act,” which was recently introduced as compromise legislation to end surprise medical billing. In a December 17 letter, AAOS President Joseph A. Bosco III, MD, FAAOS, acknowledged the significant progress made by Congress to address the longstanding problem and outlined several recommended improvements.

“Since the beginning of this process, AAOS has been consistently engaged with Congress to share our principles and find a solution that protects patients while instituting a fair independent dispute resolution (IDR) process for negotiation of disputed bills between physicians and insurers,” wrote Dr. Bosco. “The resulting legislation is not perfect but significantly improved from earlier versions.”

The “No Surprises Act” includes the use of an IDR process, instead of a government benchmark, along with important factors for consideration like prior contracting history at an equal weight to the median in-network rate. It also contains key transparency provisions for insurers including keeping accurate database records. Importantly the legislation avoids using the median-in-network rate as a mandatory interim payment and removes a dollar amount threshold for access to IDR, both which were included in earlier proposals.

“AAOS, however, would like to suggest several improvements to help avoid unintended negative impacts of the legislation to patients and physicians, especially as the nation continues to face the COVID-19 pandemic,” Dr. Bosco continued.

Suggested improvements for the bill include:

  • Reducing the burden to physicians by eliminating or lessening the impact of the 90-day waiting period following IDR.
  • Including an interim Government Accountability Office (GAO) study to better assess the impact of any wait period on the ability of smaller practices to access the IDR process.
  • Allow physicians more time to file for IDR.
  • Exclude public rates like that for Medicare, Medicaid, and Worker’s Compensation plans from consideration by the IDR entity.
  • Consider ensuring that the median in-network rate considered by the IDR entity is based on the rate for all local health plans, and not just the products of the insurer in question.

“AAOS asks that Congress continue to work to improve this impactful legislation,” concluded Dr. Bosco. “Especially during the COVID-19 pandemic, it is vital that Congress not disadvantage physicians in practices around the country delivering needed care to patients.”

Read the full AAOS letter to Congress on the No Surprises Act


About the AAOS
The American Association of Orthopaedic Surgeons (AAOS) Office of Government Relations promotes and advocates the viewpoint of the orthopaedic community before federal and state legislative, regulatory, and executive agencies. Based in Washington, DC, with additional staff in the Academy’s headquarters in Rosemont, Illinois, the Office of Government Relations identifies, analyzes, and directs all health policy activities and initiatives to position the AAOS as the trusted leaders in advancing musculoskeletal health.

For more information on all AAOS advocacy efforts, visit

Contact AAOS Media Relations 

Kristen Coultas