ICYMI: A Full Feast of Surprise Billing News Over The Holidays

Nov 30, 2021 | Blog Post

The end is in sight for surprise medical bills, and when the No Surprises Act takes effect on January 1, 2022, millions of Americans will finally be protected from these unfair charges. That historic milestone was top of mind for the Administration, policymakers and stakeholders alike at the start of the holiday season. After all, the gift of lower premiums and health care costs is one that we all can all get behind.

  • NPR: Doctors are mad about surprise billing rules. Becerra says stop gouging patients. (Nov. 22, 2021)

“The proposed rules represent the Biden administration’s plan to carry out the No Surprises Act, which Congress passed to spare patients from the shockingly high bills they get when one or more of their providers unexpectedly turn out to be outside their insurance plan’s network. The law — set to go into effect Jan. 1 — shields patients from those bills, requiring providers and insurers to work out how much the physicians or hospitals should be paid, first through negotiation and then, if they can’t agree, arbitration…‘When the arbitration process is wide open, no boundaries, at the end of the day health care costs go up, not down,’ Becerra says of the methods doctors prefer. ‘We want costs to go down. And so we want to set up a system that helps provide the guideposts to keep us efficient, transparent and cost-effective.’”

  • HHS / ASPE: Evidence on Surprise Billing: Protecting Consumers with the No Surprises Act (Nov. 22, 2021)

“…New York’s law has been in place since 2015 and has been closely scrutinized. New York uses a baseball-style arbitration, and its arbiters have received guidance to consider the 80th percentile of charges in determining the payment amount. Since the amount providers charge is typically much higher than the actual negotiated rate, this approach risks leading to significantly higher overall costs, and this has been supported by the evidence to date. Through 2018, New York’s approach had resulted in arbitration decisions that averaged 8 percent higher than the 80th percentile of charges and has the potential to alter negotiations between insurers and their network providers, leading to higher future consumer costs. A peer reviewed study in 2021 of New Jersey’s system, where billed charges or usual and customary rates are taken into consideration, also found it was associated with high payments – with a median arbitration award 5.7 times higher than median in-network commercial rates. Moreover, analysts have suggested that using benchmarks similar to those in New York and New Jersey can raise health care costs even outside the setting of surprise billing. This is because using a benchmark based on provider charges for out-of-network payment determinations can increase providers’ leverage for negotiating higher in-network rates, since insurers will otherwise face the alternative of high out-of-network arbitration awards.”

“‘As bipartisan leaders of the Committee on Education and Labor and coauthors of surprise billing legislation, we write to express our support for the recent Interim Final Rule (IFR). The IFR protects patients from surprise medical bills and properly balances the interests of all stakeholders while advancing our shared, bipartisan goal of minimizing administrative burdens and reducing health care spending.’ The letter specifically praises the approach of three Departments to resolving payment disputes through a fair independent dispute resolution (IDR) process that ensures that the qualifying payment amount (QPA) is given proper consideration during disputes. The approach adopted by the IFR will ensure consumers are protected from inflationary health care costs and ‘is consistent with legislation reported by the Committee, the text of the statute, and congressional intent.”

  • Stakeholders: More than 60 Consumer and Patient Organizations, Union and Employer Groups Call on Biden Administration to Maintain Surprise Billing Protections, Limits on IDR Ahead of Jan. 1 (Nov. 17, 2021)

“Given the recent push by some groups, including those representing Wall Street-backed providers, to reverse or undermine those consumer protections, we want to overwhelmingly express the need for them to be preserved as part of the implementation process. The rules guiding independent dispute resolution cannot be separated from consumer protections; indeed, the thoughtful approach to IDR in the interim final rules is a form of consumer protection… The approach taken in the most recent interim final rules chose patients over private equity and is a meaningful step towards lower health care costs for millions. It preserves the right of all parties to have their unique circumstances heard by an independent dispute resolution entity, recognizes the nuances of health care pricing, and should ensure use of arbitration is limited in practice. The end result will be more in-network care at more affordable rates for workers and their families.”