Healthcare expenses are set to get a lot more predictable starting in January, thanks to federal rules issued Thursday that curtail “surprise” medical bills.
Under interim rules issued by the Department of Health and Human Services and several other federal agencies, consumers will be protected from unexpected out-of-pocket charges from healthcare providers. The rules ban all surprise billing for emergency services, and restrict cost-sharing such as high co-pays in other circumstances.
The new rules are a result of the No Surprises Act, signed into law in December as part of a COVID-19 relief bill. Unexpected medical bills have become a major source of worry for consumers. Around two-thirds of those polled by the Kaiser Family Foundation in 2018 said they were worried about surprise bills for healthcare, and another poll found that such fears made almost half of U.S. adults reluctant to seek medical care. The concern is not unfounded—for people with health insurance through large employers, 18% of emergency room visits resulted in at least one surprise medical bill in 2017, according to a Kaiser analysis.
“No patient should forgo care for fear of surprise billing,” said Health and Human Services secretary Xavier Becerra in a press release. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs.”
Many of the changes restrict costs that can arise when patients receive services from doctors and other healthcare professionals who are not part of their insurance company’s network of providers. For instance, one way for surprise medical bills to occur is if a patient goes to an in-network hospital but is unknowingly treated by a provider, such as an anesthesiologist, who is not in their health insurer’s network. In those circumstances, a patient could be billed for the difference between what the treatment cost and what the insurer paid to the provider. The new rule bans such charges. They also ban non-emergency out-of-network charges without advance notice.
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