In an opinion piece, James Gelfand and Patricia Kelmar call on Congress to fix the No Surprises Act (NSA), passed in 2020, before it bankrupts patients and employers. According to the Government Accountability Office (GAO) report, the law is reducing surprise bills and increasing in-network care, with all targeted specialties seeing an increase in the share of in-network claims or a reversal of trends leading to surprises. The HHS report states that the number of patients with out-of-network (OON) accounts declined significantly from 2014 to 2022 for both emergency and non-emergency services at network facilities; in 2022, the share of OON was 24%, 17% and 40% lower for emergency services, non-emergency services in network facilities and air ambulance compared to previous years. Average claims payments fell 41% for emergency E&M services in self-insured plans and 38% in 2021-2022. However, the Independent Dispute Resolution (IDR) process resulted in $5 billion in costs from 2022-2024, with a higher-than-expected dispute volume of 190,000 in the first nine months of 2022 instead of the projected 17,000 per year, and a total of 1.5 million disputes, 85% of which were decided in favor of providers with a median bid more than 4 times the network bid rate. Some provisions of the law, such as audits of QPA calculations and requirements for cost estimates, remain partially unimplemented, causing regulatory uncertainty.