Surprise Billing

via the Centers for Medicare & Medicaid Services (CMS):

Today, the Biden-Harris Administration (the Administration), through the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments), along with the Office of Personnel Management (OPM), released a proposed rule on the No Surprises Act’s Federal independent dispute resolution (IDR) process.

In late 2020 after years of bipartisan attempts to tackle one of the uglier problems with the U.S. healthcare system, Congress somehow ended up quietly slipping in a bill which resolved a large chunk of the issue with minimal fanfare:

Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

Just over a year ago, after years of bipartisan attempts to tackle one of the uglier problems with the U.S. healthcare system, Congress somehow ended up quietly slipping in a bill which resolved a large chunk of the issue with minimal fanfare:

Over at the New York Times, Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

Last winter, after years of bipartisan attempts to tackle one of the uglier problems with the U.S. healthcare system, Congress somehow ended up quietly slipping in a bill which resolved a large chunk of the issue with minimal fanfare:

Over at the New York Times, Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

Last December, after years of failed attempts and controversy, Congress finally passed a bill which, once implemented, is supposed to mostly eliminate one of the uglier problems with our healthcare system: Surprise Bills:

Over at the New York Times, Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

via Amy Lotven of Inside Health Policy:

Becerra Pressed On Surprise Billing, Short-Term Plans, Medicare

Lawmakers from both parties pressed HHS Secretary Xavier Becerra over surprise billing implementation, Medicare policy and non-ACA-compliant plans, including the Trump-era short-term plans and Association Health Plans during a wide-ranging hearing on the department’s fiscal 2022 discretionary budget. The former congressman and California attorney general also assured GOP lawmakers that Medicare for All is not on the agenda.

...The House Progressive Caucus has called for the potential $456 billion in savings to be used to add benefits to Medicare, although the caucus also supports making permanent the ACA’s enhanced tax credits. The White House also made clear that it wants the ACA tax credits to remain.

Over six months after House Democrats passed a robust COVID-19 relief bill (only to see it continuously blocked by Republican Senate Majority Leader Mitch McConnell), it looks like Congress is finally set to compromise on a vastly stripped-down bipartisan bill which would provide at least a small amount of relief for hundreds of millions of American families and businesses.

While the bill is underwhelming (to put it mildly) overall, it does include several important provisions, one of which is a long-sought solution to a massive healthcare problem which existed long before COVID came knocking at our door nearly a year ago: Surprise Billing.

Over at the New York Times, Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

via the Washington Insurance Commissioner's Office:

OLYMPIA, Wash. – Gov. Jay Inslee today signed Insurance Commissioner Mike Kreidler’s request legislation to end surprise medical billing, enacting arguably the strongest law in the country to protect consumers from this unfair practice.

The new law protects consumers from getting a surprise bill when they get either emergency services at an out-of-network emergency room or medical treatment at an in-network hospital or facility but are seen by an out-of-network provider.

This Just In from the Washington State Insurance Commissioner's office...

Kreidler's bill to protect consumers from surprise billing passes Senate
April 10, 2019

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler’s proposal to end the harmful practice of surprise medical billing passed the Senate today on a vote of 47 to 0. It now goes back to the House of Representatives for a concurrence vote before heading to the governor’s desk.

Second Substitute House Bill 1065 (www.leg.wa.gov) prevents consumers from getting a surprise bill when they seek either emergency treatment at an out-of-network emergency room or medical services at an in-network hospital or facility but are treated by an out-of-network provider.