HealthDay News–Measures to reduce surprise medical bills for Americans are included in the COVID-19 relief bill passed by Congress.
It is estimated that about 1 in 5 emergency visits and 1 in 6 inpatient admissions lead to surprise bills that can run from hundreds to tens of thousands of dollars, the Associated Press reported. Under the new rules, the amount patients can be billed for out-of-network services will be limited to a fee based on in-network charges. The amount would count toward patients’ in-network annual deductible. Disagreements between insurers and service providers will be submitted to an independent dispute resolution process.
Patients will be protected from surprise bills related to emergency medical care if they are seen at an out-of-network facility or treated by an out-of-network clinician at an in-network hospital. In both situations, patients’ bills would be based on their plan’s in-network rate. Patients admitted to an in-network hospital for a planned procedure are also protected when an out-of-network clinician gets involved — for example, when a surgeon is called in to assist in the procedure or if the anesthesiologist on duty is not part of the patient’s plan, the AP reported.
Out-of-network service providers will generally have to give patients 72-hour notice of their estimated charges. Patients would have to agree to receive out-of-network care to be billed.
Air ambulance services will not be able to send patients surprise bills for more than the in-network cost-sharing amount. Ground ambulance services will not face the same restrictions, but the legislation calls for more examination of their billing practices, the AP reported.
The main provisions of the legislation would take effect Jan. 1, 2022.