- Bipartisan legislation went into effect on Jan. 1 that bans surprise medical billing for out-of-network costs.
- Specifically, the bill protects patients who are given emergency treatment out of their network.
- Surprise medical bills have gotten more common, and more expensive, saddling Americans with huge costs.
Americans no longer have to worry about being slapped with hundreds of thousands of dollars in surprise medical bills from providers they did not choose.
On January 1, bipartisan legislation sponsored by Republican Sen. Bill Cassidy and Democratic Sen. Maggie Hassan went into effect that bans surprise billing for out-of-network costs for emergency care. This legislation was signed into law in December 2020 as part of a bill funding the government through 2021, and it required the Department of Health and Human Services to protect patients from “outrageous” bills beginning the first day of 2022, Hassan said in a statement.
“This is a milestone in our effort to lower health care costs,” Cassidy said in a statement. “Too often patients have been blindsided by surprise medical bills, sometimes for tens of thousands of dollars. This is a victory for them. This solution is pro-patient and benefits everyone.”
According to a section-by-section breakdown, the legislation — the STOP Surprise Medical Bills Act — would protect American patients in three ways:
- Patients are only required to pay the in-network cost required by their health plan for emergency services, regardless of being treated out-of-network.
- Patients will not foot surprise costs for additional health care services after receiving emergency out-of-network care.
- And patients will owe no more than their in-network costs if a non-emergency service is provided by an out-of-network provider at an in-network facility.
In addition, providers would automatically be paid the difference for the services by insurance companies and while they would have the opportunity to appeal the payments, in which they can dispute how much they received, the patient remains removed from the process and still only owes the in-network rate.
A study published by the Journal of the American Medical Association in 2019 found that surprise medical bills have been getting more common as well as getting a lot more expensive, and can top $2,000. And a study from the Government Accountability Office in the same year found the median price for air ambulance providers could cost over $40,000, with 70% of those transports out-of-network, meaning patients were often saddled with a huge bill for medical care.
While this new legislation will give peace-of-mind to many patients, some doctors and hospitals are seeking to challenge it. In December, a group of hospital providers filed a lawsuit that argued President Joe Biden’s administration misread the law’s language and could cause their payments to fall because the new arbitration system leans too heavily on typical care prices and does not equally weigh other factors, like the doctor’s experience. But they’re not looking to revoke consumer protections.
Still, as the New York Times reported, this legislation does not mean all surprise medical billing is a thing of the past. The bill only protects patients from extra charges from a provider they did not choose, so when seeking non-emergency care, it’s always important to ensure the doctor is within network to avoid unexpected and expensive costs.
Have you dealt with surprise medical billing? Reach out to Ayelet Sheffey at firstname.lastname@example.org to share your story.