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Congress set to ban surprise medical billing
Old 12-21-2020, 11:32 AM   #1
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Congress set to ban surprise medical billing

At last...

Congress set to ban surprise medical billing in year-end spending package

Quote:
Congress is poised to include a ban on "surprise" medical bills as part of its massive year-end spending package that lawmakers are expected to vote on Monday.

... " [a] bipartisan, bicameral legislation that will end surprise billing for emergency and scheduled care" will be part of $1.4 trillion spending bill, which also includes an additional $900 billion in coronavirus relief money.
This should have been passed years ago.
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Old 12-21-2020, 12:02 PM   #2
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It hasnít passed yet, so hopefully we donít jinx it, but ... this is definitely one of the best things to happen this year.
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Old 12-21-2020, 12:38 PM   #3
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It hasnít passed yet, so hopefully we donít jinx it, but ... this is definitely one of the best things to happen this year.
Let's end the year on the upswing. Vaccine, and now this.

It is about time. I had surgery 4 years ago and was promised it was in network. This was important as I would hit my in-network high deduction amount, and the rest of the surgery was covered. All was good for 3 months, then, out of nowhere, I get this out-of-network charge for about $300 from the doctor who checked me in. You know, asks a few questions, marks them down on a clipboard, and then is gone.

Arggghhh!
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Old 12-21-2020, 10:12 PM   #4
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What's the difference between getting a surprise bill and just not knowing that the doctor or facility is out of your insurer's network?

What scenarios does this legislation protect?
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Old 12-21-2020, 11:05 PM   #5
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Originally Posted by teej1985 View Post
What's the difference between getting a surprise bill and just not knowing that the doctor or facility is out of your insurer's network?

What scenarios does this legislation protect?
The law doesn't distinguish.

It appears to eliminate prior authorization expectations and requires insurers to essentially cover the services at in-network rates.

See page 4,096 of the 5,593 page bill they're passing now.
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Old 12-21-2020, 11:50 PM   #6
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https://www.yahoo.com/news/surprise-...130013583.html

Ok, Yahoo may not be the best news source, but based on the article it looks like the bill will be focused on protecting against going to the ER, for example, and ending up with one or more out of network providers when you are there.


I have to say that the article burns me up because it demonstrates how Americans’ well being and health care are being held hostage by powerful lobbyists and private equity firms. I hope I don’t get in trouble for this statement; it is nonpartisan. But to read how doctors and private equity firms spent a fortune to lobby against this bill, and it passed because the health insurance companies’ lobbyists were more powerful, well, that just makes me sick.
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Old 12-21-2020, 11:56 PM   #7
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Originally Posted by teej1985 View Post
What's the difference between getting a surprise bill and just not knowing that the doctor or facility is out of your insurer's network?

What scenarios does this legislation protect?
Ax @Joe Wras shared...it's Doctors & others that can be ancillary to a hospitalization. The Dr that does a drive by check in The oncologist that looks at your chart & says...yep it's cancer. You never authorized it. You never saw him/her. But it gets billed to you anyway

These are subcontractors to your hospital/practice
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Old 12-22-2020, 12:16 AM   #8
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I had a cheek bone fracture from a bad fall and was transported by an ambulance to a county hospital. I was shock about the medical bill for only a night of stay. It was almost $30K. A week later, I had a surgery to repair the cheek bone fracture. The cost of that outpatient procedure was another $22K. The medical bills or care in the U.S are out of this world!

BTW, the surgery damaged my facial nerve. The numbness or tingling is still present over a year.
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Old 12-22-2020, 04:53 AM   #9
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Doctors and hospitals bill outrageous amounts and insurers only pay a fraction of the amount billed. This is especially true for hospitals and procedures. Overall not true for primary care in the office.

I have no idea how much I overcharged in a hospital based inpatient practice. I was on salary and billing was done by the nationally-based company. Twice our national company failed to negotiate a contract with a major insurer. Our local practice ended up with a separate agreement to charge in-network rates. But our small office staff had to meet with affected families and give them paperwork to explain the workaround. We provided newborn care on behalf of most of the family practices in the area. We actually didnít want to be out-of-network, but it was out of our control. It was a mess.

I refused to join the AMA, and never donated to any medical organization PACs. The big organizations donít seem to realize that we docs are also health care consumers.
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Old 12-22-2020, 05:51 AM   #10
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Originally Posted by Scrapr View Post
Ax @Joe Wras shared...it's Doctors & others that can be ancillary to a hospitalization. The Dr that does a drive by check in The oncologist that looks at your chart & says...yep it's cancer. You never authorized it. You never saw him/her. But it gets billed to you anyway

These are subcontractors to your hospital/practice
Right! And the dirty secret is that some of these doctors frequently have some sort of loose affiliation with your in-network provider group. So the original providers get a cut in the action.

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I refused to join the AMA, and never donated to any medical organization PACs. The big organizations donít seem to realize that we docs are also health care consumers.
You sound like my primary care doc! He's a good guy and keeps his independence.
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Old 12-22-2020, 06:02 AM   #11
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It hasnít passed yet, so hopefully we donít jinx it, but ... this is definitely one of the best things to happen this year.
+1
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Old 12-22-2020, 07:02 AM   #12
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More details from the Associated Press on what the bill covers:

Consumer relief: COVID bill to end Ďsurpriseí medical bills

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WASHINGTON (AP) ó People with private health insurance will see the nasty shock of ďsurpriseĒ medical bills virtually gone, thanks to the coronavirus compromise passed by Congress.
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Old 12-22-2020, 07:21 AM   #13
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More details from the Associated Press on what the bill covers:

Consumer relief: COVID bill to end Ďsurpriseí medical bills
That's an informative article. Yeah, journalism still exists!

Here's one interesting point, however. Like all things concerning health these days, patience is in order:
Quote:
The main provisions of the legislation would take effect Jan. 1, 2022.
There could be some last minute grabbing occurring this year 2021.
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Old 12-22-2020, 07:26 AM   #14
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My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/hea..._medical_bills


Does the proposed Federal legislation make it nation-wide?
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Old 12-22-2020, 07:28 AM   #15
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My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/hea..._medical_bills


Does the proposed Federal legislation make it nation-wide?
Yes. The article explains it well, and also why sometimes the state laws fall short.
Quote:
Although states have been moving to curb surprise billing, federal action was needed because states do not have jurisdiction over large employer plans that cover tens of millions of workers and their families.
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Old 12-22-2020, 07:29 AM   #16
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Originally Posted by CuriousJoe View Post
My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/hea..._medical_bills


Does the proposed Federal legislation make it nation-wide?
From the AP article linked above:

Quote:
Although states have been moving to curb surprise billing, federal action was needed because states do not have jurisdiction over large employer plans that cover tens of millions of workers and their families.
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Old 12-22-2020, 11:09 AM   #17
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Yes, a lot of MegaCorps like the one I retired from do self-insurance, where the insurance company just handles the claims but the corp pays the bills. So they're not covered by state regulators (a nasty loophole IMO, all insurance should be regulated).
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Old 12-22-2020, 11:33 AM   #18
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There is a huge amount of wasteful spending in this bill but this stopping of surprise medical billing is a very good thing. It should have been done years ago.
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Old 12-22-2020, 11:41 AM   #19
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Fingers crossed that this gets signed!
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Old 12-22-2020, 12:30 PM   #20
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This is very good news. Long term it might be the best thing to come out of this package. I don't know how a health care consumer could do anything but support this one. Sure, if you freely elect out of network service ahead of time, pay for it, but no one should go to a network facility, have the reasonable expectation of in-network coverage, only to be billed $10K because the anesthesiologist was out of network, unbeknownst to the patient.

Sounds like providers and insurers are going to have to negotiate how this is paid, going to arbitration if necessary. But the key thing is that they can't go after the patient for it.
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