HHS Releases Details on How Surprise Medical Bill Disputes Will Be Resolved
Ahead of greater consumer protections against unexpected out-of-network charges taking effect on Jan. 1, the Department of Health and Human Services issued an interim rule Thursday that outlines an arbitration process that will settle disagreements between insurers and providers over costs. The Biden administration's approach is favored by the insurance industry.
AP:
Ban On 'Surprise' Medical Bills On Track For Jan. 1 Rollout
The Biden administration on Thursday put final touches on consumer protections against so-called “surprise” medical bills. The ban on charges that hit insured patients at some of life’s most vulnerable moments is on track to take effect Jan. 1, officials said. Patients will no longer have to worry about getting a huge bill following a medical crisis if the closest hospital emergency room happened to have been outside their insurance plan’s provider network. They’ll also be protected from unexpected charges if an out-of-network clinician takes part in a surgery or procedure conducted at an in-network hospital. In such situations, patients will be liable only for their in-network cost sharing amount. (Alonso-Zaldivar, 9/30)
Stat:
Biden Administration Favors Insurers Over Doctors In Surprise Billing Rule
The Biden administration on Thursday sided with insurers over physicians, hospitals, and other health care providers, choosing the approach they prefer for resolving disputes over surprise medical bills. Congress last year passed a landmark law to protect patients from getting large, unexpected bills in emergencies and non-emergency situations where patients can’t choose their doctors. But many of the controversial details of its implementation were left to the Biden administration. The law barely passed after an all-out, yearslong lobbying war between health care providers and insurers. (Cohrs, 9/30)
Modern Healthcare:
HHS Lays Out Surprise Billing Resolution Process In New Rule
Under the interim final rule published Thursday, if an out-of-network provider and payer can't come to an agreement over payment during a 30 day "open negotiation," they may turn to an independent dispute resolution process. The rule "takes consumers out of the middle of a payment dispute between insurers and providers," a Health and Human Services official told reporters Thursday. (Hellmann, 9/30)
The Wall Street Journal:
Medical Cost Disputes To Be Settled By Arbitrator
The new system stems from the No Surprises Act, a milestone legislation for patient advocates and lawmakers because it aims to limit out-of-pocket costs for unexpected medical bills. It applies to more than 130 million people with employer-sponsored health plans covered by federal law and many people who live in parts of the country without a state-based law that bans surprise bills. The 2020 No Surprises Act goes into effect on Jan. 1. The legislation directs insurers and providers who can’t agree on a reimbursement amount to submit to arbitration. It also tasked the administration with setting up the independent resolution process, which has had hospitals and insurers sparring over whether the system will financially favor the other, as third-party dispute resolutions could affect their bottom lines. (Armour, 9/30)
