Legislation included in relief package would lower amount of surprise medical bills

Posted at 2:55 PM, Dec 22, 2020

Tacked onto the coronavirus stimulus bill is new legislation tackling one of the most controversial practices in health care – surprise medical bills.

That's when you go to the hospital or have an elective procedure and then later find out some of the doctors or facilities were out of network, meaning you could owe tens or hundreds of thousands of dollars.

The most impactful part about the legislation is that patients would no longer get those surprise out-of-network bills for emergency care or for a planned procedure. They will instead be billed an in-network rate.

Out-of-network providers would have to give patients a heads up on estimated charges, at least three days.

Air ambulance companies would also not be able to charge more than in-network costs. Ground ambulances were not included.

Insurance and providers have to go to arbitration to work out the final payment. It's a complex solution advocates say could end up costing Americans more in the long run.

“So, a mediation process that some states have put in place, but research has shown that it increases the likelihood that consumers face higher premium costs on the back end,” said Clare Krusing with the Coalition Against Surprise Medical Billing.

That Coalition had been pushing for policies that, in their simplest form, would have essentially made in and out-of-network rates the same. Savings that in-part would have funded community health centers.

“Not only is that approach the cleanest way of dealing with this, but it also saves the patients and taxpayers the most money, who are going to save $25 billion over 10 years.

The group plans to continue to push for more terms around that arbitration process to prevent abuse, driving up costs.

None of the new surprise medical bill legislation takes effect until January 2022.