Surprise Billing Coming to an End for Patients

Surprise Billing Coming to an End for Patients

One of the issues high on TSCL’s agenda this year was putting an end to the practice of “surprise billing.”

Surprise billing is when patients incur “surprise” medical bills when they unexpectedly receive out-of-network services in an emergency, or for services such as anesthesia and radiology that were provided by doctors or others who do not accept the patient’s insurance plan. Out-of-network care is usually more expensive than in-network care with higher coinsurance rates or no coverage at all.

As a result, patients have ended up with thousands of dollars in medical bills they thought were covered by their health insurance.

Because of the new legislation, patients will no longer have to worry about those surprise bills.  Instead, doctors are going to have to fight it out with insurance companies about how much to pay.

(It should be noted that transportation of a patient by a ground ambulance is not covered by the legislation and patients will still be liable for the cost if their insurance does not cover it.)

In an article in Politico, it was pointed out that doctor groups have spent millions of dollars fighting to stop legislation that would end surprise billing.  And it turns out their investment paid off.

According to Politico, “Powerful hospital and physician groups that tied up Congress for nearly two years on how to end “surprise” medical bills saw their efforts pay off with the compromise lawmakers inserted in the giant year-end spending package.

“The health care providers — including private-equity backed physician staffing groups — chipped away at leading legislative proposals through high-profile lobbying and tens of millions of dollars’ worth of attack ads while promoting a solution that would submit their payment feuds with insurers to independent mediators.”

The article continued with this: “Elizabeth Mitchell, president of the Pacific Business Group on Health, which represents large employers including Walmart and major tech companies, predicted the legislation will yield an ‘opaque, expensive bureaucratic process’ favoring ‘those with the resources to navigate that most effectively.’

“’These bills will still end up driving up premiums overall,’ Mitchell said.”

And then there is this: “One insurance lobbyist said the outcome showed how private equity-backed physician groups and hospitals dictate policy, adding, ‘For consumers, this will mean higher and higher costs, year over year, forever.’”

So, while patients will no longer receive surprise bills, in the long run insurance companies may increase premiums on everyone to cover the costs.  That, at least, is the opinion of insurance companies and large employers.

Nonetheless, we are pleased that individual patients will no longer face these unexpected and costly medical bills.