In a major initiative to keep patients away from financial hardships. The U.S. Department of Health and Human Services (HHS) on July 1, 2021, unveiled a new interim final rule. That will protect patients from “excessive” out of pocket costs stemming from surprise medical bills. The rule banning surprise billing, as well as some out-of-network charges, will go into effect on January 1, 2022, for providers. And insurance plans that begin on or after that date.
According to details, the final rule is an implementation of the No Surprises Act. Which was passed by Congress last year aimed at protecting consumers from burdensome out-of-network bills. The Department of Labor, the Treasury Department and the Office of Personnel Management were all co-authors of the interim final rule. Implementation of this rule will enable patients to get emergency medical aid without worrying about unknowingly accepting out-of-network care. And subsequently facing surprise billing expenses. As a result, patients will get the financial peace of mind they deserve.
No doubt, prohibitions already exist for balance billing in both Medicare and Medicaid. But this rule will extend similar protections to Americans insured through commercial and employer-sponsored health plans.
Key provisions of the interim final rule will now prohibit
- Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
- Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
- Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
- Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
HHS Secretary Becerra in an official statement said that: patients should not show reluctance in getting medical care services just because of the fear of surprise billing. Moreover, she added that the Biden-Harris Administration is committed to ensure transparency and affordable care to Americans. This rule will make sure that patients won’t be saddled with unexpected costs. Furthermore, U.S. Secretary of Labor, Marty Walsh in her remarks said that: “No one should ever be threatened with financial ruin simply for seeking needed medical care,”. “Today’s Interim Final Rule is a major step in implementing the bipartisan No Surprises Act that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers.”
What is Surprise Medical Billing?
It’s pertinent to mention here that surprise billing can happen for both emergency as well non-emergency care services. It occurs when a patient unknowingly gets healthcare services that are outside of their insurance plan’s network. It has been observed that surprise billing is impacting individuals and their families negatively. Additionally, approximately two-thirds of all bankruptcies filed in the United States are connected to medical expenses.
According to research, 1 of every 6 emergency room visits and inpatient hospital stays involve care from at least one out-of-network healthcare provider. That eventually results in unexpected medical bills. In addition to this, a study by the Government Accountability Office (GAO) found that the median price charged by air ambulance providers ranged from $36,400 to more than $40,000. Over 70% of these transports were furnished out-of-network, meaning most or all costs fell to the insured individual alone
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