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Millions of Americans with private health insurance experience some kind of surprise medical billing, according to a new government report released less than six weeks before the No Surprises Act goes into effect.
Surprise medical bills are relatively common among privately-insured patients and can average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants and $750 for childbirth-related care, according to the report from the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
Consumers often expect their employer-sponsored insurance will shield them from high out-of-pocket costs for emergency services, HHS said. Unfortunately, the ASPE report reveals that an estimated 18% of emergency room visits by individuals with large employer coverage resulted in one or more out-of-network charges, and this percentage varies greatly by state, ranging from a low of 3% in Minnesota to a high of 38% in Texas.
Another finding is that patients receiving a surprise bill for emergency care paid physicians more than 10 times as much as patients without a surprise bill for emergency care.
WHY THIS MATTERS
The report’s release coincides with the No Surprises Act taking effect on January 1, 2022.
It follows Friday’s announcement about the establishment of a new federal Ground Ambulance and Patient Billing (GAPB) Advisory Committee. GAPB is to protect consumers from exorbitant charges and balance billing when using ground ambulance services, HHS said.
The No Surprises Act gives patients who have individual or employer health coverage relief from surprise medical billing, HHS said. The bill will also help reduce healthcare costs.
Individuals can no longer be balance-billed for emergency and certain non-emergency services in most circumstances. Patients will be removed from payment disputes that must be settled between providers and insurers.
Further, the Congressional Budget Office has predicted that the No Surprises Act will reduce health insurance premiums for consumers, HHS said.
THE LARGER TREND
On September 30, the Administration released an interim final rule with comment period detailing the process for resolving disputed claims that ensures patients do not end up with surprise bills. Comments are still being taken on this rule.
While many states have taken steps to try to address surprise billing, state laws have left critical consumer protection gaps that will be addressed under the No Surprises Act, HHS said. State insurance rules do not apply to self‐insured employee benefit plans, which cover 67% of workers with employer‐sponsored health coverage.
The ASPE report describes how 18 states have addressed surprise medical billing, while an additional 15 states have taken partial steps.
These efforts include establishing standard payment rates to restrict high variation for out-of-network charges and dispute resolution processes to resolve additional payments for which patients may no longer be held responsible.
Additionally, research has found that some state efforts to resolve surprise billing payment disputes have resulted in increased healthcare costs. The implementation of the No Surprises Act is designed to address these gaps in state policies and apply protections against surprise billing nationwide.
The ASPE report underscores the critical need for immediate nationwide protections to ban surprise medical billing.
ON THE RECORD
“No one should have to worry about going bankrupt after falling ill or seeking critical care,” said Health and Human Services Secretary Xavier Becerra. “Today’s report shows that despite some state efforts to tackle surprise medical bills, patients continue to experience exorbitant medical expenses due to lack of transparency and rules.”
“Protecting people from devastating surprise medical bills, especially for something beyond their control like needing an ambulance during an emergency, is a top priority for the Biden-Harris Administration,” said CMS Administrator Chiquita Brooks-LaSure. “We invite subject matter experts to apply for membership on the GAPB Advisory Committee and provide thoughtful recommendations that will help prevent balance billing and alleviate burdensome financial challenges for consumers.”
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