Congress set to ban surprise medical billing

[REWahoo]

At last...

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

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.

 

[MichaelB]

It hasn’t passed yet, so hopefully we don’t jinx it, but ... this is definitely one of the best things to happen this year.

 

[JoeWras]

It hasn’t passed yet, so hopefully we don’t 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!

 

[teej1985]

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?

 

[SecondCor521]

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.

 

[Poopycat]

https://www.yahoo.com/news/surprise-medical-bills-cost-americans-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.

 

[Scrapr]

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

 

[Spanky]

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.

 

[EastWest Gal]

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 didn’t 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 don’t seem to realize that we docs are also health care consumers.

 

[JoeWras]

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.

I refused to join the AMA, and never donated to any medical organization PACs. The big organizations don’t 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.

 

[Dtail]

It hasn’t passed yet, so hopefully we don’t jinx it, but ... this is definitely one of the best things to happen this year.

+1

 

[REWahoo]

More details from the Associated Press on what the bill covers:

Consumer relief: COVID bill to end ‘surprise’ medical bills

WASHINGTON (AP) — People with private health insurance will see the nasty shock of “surprise” medical bills virtually gone, thanks to the coronavirus compromise passed by Congress.

 

[JoeWras]

More details from the Associated Press on what the bill covers:

Consumer relief: COVID bill to end ‘surprise’ 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:

The main provisions of the legislation would take effect Jan. 1, 2022.

There could be some last minute grabbing occurring this year 2021.

 

[CuriousJoe]

My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills


Does the proposed Federal legislation make it nation-wide?

 

[JoeWras]

My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/health_insurance/surprise_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.

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.

 

[REWahoo]

My understanding is that some of the states have already this protection.For ex.New York state:
https://www.dfs.ny.gov/consumers/health_insurance/surprise_medical_bills


Does the proposed Federal legislation make it nation-wide?

From the AP article linked above:

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.

 

[GTFan]

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).

 

[aaronc879]

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.

 

[audreyh1]

Fingers crossed that this gets signed!

 

[ziggy29]

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.

 

[audreyh1]

I heard vague references to it a while back, but didn't realize I was already protected by a Texas law that went into effect on Jan 1 2020.
https://www.bcbstx.com/provider/news/2020_04_13.html

 

[ziggy29]

I heard vague references to it a while back, but didn't realize I was already protected by a Texas law that went into effect on Jan 1 2020.
https://www.bcbstx.com/provider/news/2020_04_13.html

More states are doing this. This has been Oregon law since mid-2018. Colorado passed fairly extensive legislation that took effect on 1/1/2020. But those folks with national plans that cover beyond state lines can benefit too, since now they will be protected from surprise billing if they need care while outside their home state.

 

[jollystomper]

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).

Yes, this bill is a good thing.

AN interesting thing we had noticed was, when our Megacorp switched insurance administrators a couple of years ago, was that we were assigned and "advocate" as well as a "hotline number". Among the things we could use it for were billing issues. We did use them for a billing issue, I do not believe directly related to this topic, but the gist of it was "we'll take it from here", and the result was a corrected bill from the provider. My guess is that this is one of the things Megacorp negotiated with the insurer for the insurer to gain their business. The law will be helpful to further back it up.

 

[audreyh1]

NPR article said that "In Texas, federally regulated plans account for roughly 40% of the state's health insurance market."
https://www.npr.org/sections/health...latest-state-to-attack-surprise-medical-bills

 

[Popeye]

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.

If insurers end up paying more, won’t they try to roll it into premiums in the long term? Ofc, it’s better if everyone pays a tiny bit more instead on a few getting clobbered.