HHS Secretary Xavier Becerra oversees the federal health department charged with ensuring patients can’t get hit with pricey surprise medical bills. While all eyes were on Congress, the Biden administration handed insurers a victory in a much-anticipated rule detailing how to shield patients from pricey, unexpected medical
bills. The effort is critical to protecting Americans from bankruptcy after receiving skyhigh charges through no fault of their own. And it’s served as a perennial reminder that changing the health-care system is exceedingly complex — and contentious.
Here’s the quick backstory:
Patients get hit with hefty surprise medical bills when they unknowingly get care from a doctor out of their coverage network or in emergency situations, where they can be sent to out-of-network hospitals.
The issue was the center of a ferocious lobbying battle on Capitol Hill for nearly two years, pitting powerful insurers and providers against each other.
In December, lawmakers reached a compromise and passed legislation that protected patients from surprise medical bills.
Providers successfully pulled the bill further in their direction after spending tens of millions of dollars in ads to promote their preferred fix. But the law charged the federal health department with hashing out some of the thorniest details.
How the dispute plays out: Doctors and insurers have 30 days to negotiate the remaining charges of the bill. Afterward, a mediator can step in if they can’t agree, and both sides will submit offers.
Insurers cheered the administration’s rule, which is set to take place beginning Jan 1. 2022, while providers sent scathing statements.
Here’s a sampling:
Major insurer lobby AHIP called the rule “the right approach” to encourage providers and insurers to “negotiate in good faith.”
A coalition of mainly insurer and employer groups said the rule adhered to Congress’ intent on what mediators should take into consideration when settling disputes.
The Federation of American Hospitals, which represents for-profit chains, slammed the rule as a “total miscue” and “put[ting] a thumb on the scale benefiting insurers against providers.”
The American Hospital Association echoed that sentiment, saying the rule “moved away from Congressional intent.”
The Biden administration also laid out rules to help uninsured patients contest bills that seem too expensive. Doctors and hospitals will be required to provide an estimate of the price of a procedure beforehand. The federal health department set up a process for patients to dispute their bill if the cost is at least $400 more than the “good faith” estimate they were given.
Key points for patients to act upon: If you receive a surprise medical bill, challenge it.