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New Surprise Medical Billing Law Has Significant Impact

survey and analysis conducted by Blue Cross Blue Shield Association (BCBSA) and America’s Health Insurance Plans (AHIP) found that in just two months, the HR Policy-Supported No Surprises Act prevented more than two million surprise bills for commercially insured patients. 

If this trend holds, the law will prevent 12 million surprise bills in 2022. In a statement released by the Association-supported Coalition Against Surprise Medical Billing, HR Policy President and CEO Tim Bartl referenced employee concerns with rising inflation and noted that it “shouldn’t be made worse by backtracking on the surprise billing rules in ways that will increase employee health care premiums and deductibles and drive up employer costs.” 

Refresher on the No Surprises Act: The law went into effect on January 1, 2022 and prohibits providers from billing a patient above their in-network rates in situations where the individual is treated by an out-of-network provider for emergency services or at an in-network facility. The legislation also set up an independent dispute resolution (IDR) process for solving payment disputes between providers and plans. The IDR process is at the heart of provider lawsuits against the administration, which argue that the use of the qualifying payment amount (i.e., median in-network payment rate) as the primary consideration for arbiters tips the scale in favor of plans. 

Majority of voters worried about ongoing lawsuits: A Morning Consult poll shows 79% of voters are concerned that the current lawsuits will delay or impact the patient protections in the No Surprises Act.

Outlook: The ongoing lawsuits challenging the No Surprises Act and regulatory rules may impact the final rules expected sometime this summer. HR Policy continues to engage with the Departments on the final rule, urging them to remain committed to the goal of lowering health care costs by setting up an IDR process that first considers the qualifying payment amount before evaluating other factors. 

Published on: May 27, 2022

Authors: Margaret Faso

Topics: Transparency, Quality and Cost Containment

Margaret Faso

Director of Health Care Research and Policy, American Health Policy Institute and HR Policy Association

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