Beginning Jan. 1, 2022, millions of Americans will be protected from the threat and financial harm of surprise medical bills. Maintaining these important consumer protections, including a limited process for independent dispute resolution (IDR), is essential for patients to see the full benefit of the No Surprises Act.
In a new letter to the Biden Administration, the more than 30 members of the Coalition Against Surprise Medical Billing commended the tri-agencies for their work to ensure that American patients, families, employees and union members have comprehensive safeguards in place against the flawed business practices of private equity firms and out-of-network providers.
Highlights from the letter are included below:
- “As the country quickly approaches a pivotal milestone for patients who have faced the financial threat and harm from surprise medical billing, we want to commend the Biden-Harris Administration for its ongoing commitment to protecting consumers from these unfair and egregious out-of-network charges.”
- “For years, surprise billing has proliferated as a lucrative business model for private equity-backed providers and other out-of-network entities seeking to extract maximum profit from patients, families, employers and employees across the country. As organizations providing health benefits and coverage to millions of Americans, we have been longstanding proponents of comprehensive reforms to address this widespread affordability crisis.”
- “As noted in the September 30 interim final rule, ‘the balance billing provisions in the No Surprises Act have the potential to decrease health care spending…When the rules become effective, they will provide patients immediate protection against balance bills, reducing their exposure to out-of-pocket medical expenses. The Congressional Budget Office has projected that the No Surprises Act will reduce private health plan premiums by 0.5%-1% on average and reduce the federal deficit by $17 billion over 10 years.’”
- “Leading policy experts have made clear that achieving the cost-savings intended by the No Surprises Act is only possible by maintaining the qualified payment amount (QPA) as the primary and overriding consideration for final payment determinations during the IDR process. The Interim Final Rule Part II provides clear and important direction to arbitrators based on the statute that they ‘must begin with the presumption that the QPA is the appropriate [out-of-network] amount’ and that ‘for the independent dispute resolution entity to deviate from the offer closest to the QPA, any information submitted must clearly demonstrate that the value of the item or service is materially different from the QPA.’”
- “Importantly, as the interim final rule states, ‘anchoring the determination of the out-of-network rate to the QPA will increase the predictability of IDR outcomes, which may encourage parties to reach an agreement outside of the Federal IDR process to avoid the administrative costs, and will aid in reducing prices that may have been inflated due to the practice of surprise billing prior to the No Surprises Act.’ By reinforcing the importance of a predictable and limited arbitration process, the latest rule helps achieve a critical goal of improved access to affordable, in-network care.”
- “Preserving these safeguards as part of the law’s implementation is a top priority for all organizations representing patients, union members, employers, employees and the families who stand to benefit the most from these reforms. We appreciate all the work your departments have done to protect patients from surprise medical bills, and we look forward to continuing to work with you to implement these important consumer protections.”
To read the full letter, click here.