After years of being hindered by well-funded interests, Congress has agreed to ban one of the most expensive and frustrating practices in medicine: surprise medical bills.
Surprise bills result from an out-of-network provider being compelled to be unexpectedly involved in a patient’s care. Patients who go to a hospital that accepts their insurance may have to be treated by an emergency room physician who doesn’t accept the same. Such doctors will often bill those patients with fees that extend their regular health plans.
The new changes that will take effect in 2022 will apply to doctors, hospitals, and air ambulances (excluding ground ambulances). As per the new bill, health providers will now have to work with insurers to settle on a fair price instead of charging the patients exorbitantly.
According to research, millions of Americans receive such surprise medical bills each year, with as many as every 1 in 5 emergency room visits resulting in a surprise medical bill. These bills are mostly raised by health providers whom the patients do not have the liberty to select, including emergency room physicians, anesthesiologists, and ambulances, among others. Though the average surprise charge for an emergency room visit is slightly above $600, patients have been charged with bills exceeding $100,000 by out-of-network providers whom they did not select.
Out of several issues surrounding the complex American health system, surprise billing was one rare concern that both the political parties could get behind. Health committee leaders and the White House have been engaged on the issue for years. President-elect Joe Biden, supported by many prominent legislators, including Sen. Lamar Alexander, R-Tenn., and the retiring chairman of the Senate Health Committee, included the proposal in his campaign health care agenda.
Hospitals and doctors, who have benefited from the current system of surprise medical bills, fought to defeat countermeasures that would lower their income. On the other hand, insurance companies seek to negotiate lower payments with such medical providers who may send surprise medical bills to the patients.
The Legislation, which was to be passed last December, was hindered by health providers who fought against the deal aggressively. Private-equity firms, who own many of the medical providers that deliver surprise bills, paid tens of millions into ad campaigns to oppose the plan. As a result, committee chairs squabbled over jurisdictional issues and postponed the issue.
“This was a real victory for American people against moneyed interests,” said Frederick Isasi, executive director of Families USA. “This really was about Congress recognizing in a bipartisan way the obscenity of families who were paying insurance still having financial bombs going off.”
Insurance groups and medical providers who disagree on a standard payment will have to negotiate through an outside arbiter who will help them determine a fair amount based on what other health providers are generally paid for similar services. However, patients can not be charged more than what they would pay for in-network services.
This, in turn, will be more advantageous to health care providers than the other proposal made by Congress wherein the role of arbiters would have been minimized in favor of set benchmark reimbursement rates. As a result, several states would have had to set up their own arbitration systems.
The new law will bar air ambulances from charging patients with surprise medical bills, which though infrequent, tend to be very large. In Pennsylvania, a coronavirus patient received a $52,511 surprise air ambulance bill this summer for a flight between two hospitals that took place while she was unconscious. States that ban surprise medical bills have been prevented from tackling such cases as federal law prevents them from monitoring air transit fees.
Ground ambulances, which generate a substantial number of surprise medical bills, are also excluded from the new law.
Health insurers are bound to be disappointed with the new laws, whereas health providers have offered a more mixed response. Some have cited the COVID-19 pandemic as a reason to delay new rules.
This is how the proposed bill plans to ban surprise medical bills and relieve millions of Americans from exorbitant bills. When looking for the right health insurance coverage, don’t hesitate to contact the experts at Donald Weiss Insurance Services. Our dedicated team is ready to assist you with all your insurance needs.