The Latest Congressional Act to Save You from Sneaky Medical Bills
Have you received an astronomically high bill you didn’t expect?
We’ve already spoken about how one of the top concerns in retirement is medical bills. Well, not only are retirees afraid, most Americans are afraid of surprise Medical bills as well.
Congress recently passed a bill to provide you with an insurance policy. The cost saving measure not only provides medical bill relief, but Coronavirus relief funding for the rest of the fiscal year.
So which medical bills are you protected from? The legislation protects you from unexpected out-of-network charges. Say that you went to a specialist or you were on a ski vacation and needed an air lift due to an accident, if either of these are out of network, you could receive a crazy expensive bill in the mail. Now that can no longer happen.
How did this come to be? The Congressional Act was a surprise all around, from payers to providers to politicians and insurance companies because it has been attempted and lobbied against for years. This time around no one was able to get what they wanted, so the efforts to block the measure failed. The biggest compromise was over how much providers will receive from the market. Policies have winners and losers, and this time around, the loser isn’t the consumer as they will finally be protected from surprise medical bills.
Here’s what it means for consumers:
Fewer surprise bills
Starting in 2022, if you are treated out of network without your knowing, you will be charged your in network copays and deductibles. This leaves the insurance companies and providers to work out the difference. For those who are uninsured and therefore always out of network, they will rely on the Department of Health and Human Services to adjudicate a provider-patient bill dispute process. The bill does not cover ground transportation out of network yet, but it does cover other emergency services. Congress is working on measures for out of network ambulance services.
2. Consumers have the option for balance billing
Say your doctor wants you to see a specialist who just happens to be out of network. They are required to provide you with the choice to see the specialist so you have an option to refuse the higher cost service. The rule is that the patient needs to be notified 72 hours prior to seeing the specialist, surgeon, etc. so they have a chance to think about the financials and weigh their options. If it’s a last minute option, patients must be notified that day and consent before the appointment is made. The provider needs to give you a good faith estimate of the cost, allowing you to choose what you can afford. This applies in non-emergency situations.
3. Payment disputes between providers and insurers to be sorted through negotiation
One of the largest obstacles to a bill like this is sorting out the payment disputes and discrepancies between providers and health insurance companies. Usually the consumer suffers by footing the bill for the lack of agreement between providers and insurers. Now, they will need to settle the dispute themselves, within 30 days of the procedure/occurrence of the out of network cost. If they fail to settle, then the case is brought to an arbiter who will have a final say. Hospitals and physicians cannot use their “billed charges'' or time to settle the dispute during arbitration.
4. States also need change
The Congressional Act is a catalyst for many states to ratify and extend the rights outlined for consumers and employers. That being said, states may or may not support the Federal rules based on their own definitions, or lack thereof, for detailing out of network costs. As we see often, the Federal ruling holds supremacy over the State, but it’s up to individual states to create the legal infrastructure for the Federal rulings to exist at the state level. That being said, the Federal rules do cover most types of insurance plans including those for the self-employed. Because it’s complicated for each state to set the rules themselves, we do expect the trend to be that each state will mould to the Federal laws. Look for more to come!
As we know law moves slowly and often creates a “tip of the iceberg” situation. We are expecting this to set a precedent that leads states in the right direction of common sense medical billing saving the consumer and setting rules for payers and providers.
source: https://www.nytimes.com/2020/12/20/upshot/surprise-medical-bills-congress-ban.html