Americans will now be protected from most surprise bills, said Eagan Kemp, health care advocate at Public Citizen. However, Kemp said, Congress still needs to act to protect Americans from surprise bills for ground ambulances.
The changes take effect on Jan. 1, 2022.
Surprise bills are those you get when an out-of-network medical provider unexpectedly gives your care. The new law stops the practice of making consumers responsible for the difference between the provider’s charge and their insurer’s allowed amount – a practice called balance billing.
The new law also requires that all emergency room medical care is billed at “in-network” rates, which is lower to a consumer. The law also:
- Creates a framework that takes patients out of the middle, and allows health care providers and insurers to resolve payment disputes without involving the patient. Insurers will make a payment to the provider that is determined either through negotiation between the parties or an independent dispute resolution process.
- Prohibits balance billing patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care.
Kemp said the use of arbitration to resolve disputes between insurers and providers – instead of using pre-set benchmark rates – means further inflation of the nation’s already high inflated health care costs.
“Oversight will be crucial to prevent abuses, especially by private equity-backed providers that use surprise bills to bilk patients,” he said.
Private equity-backed providers are likely to try to take advantage of the arbitration process to drive up their compensation over time at the behest of their corporate overlords, Kemp said.