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so often when we discuss matters of u.s
healthcare policy on this channel the
good news seems scarce but today we've got some pretty good news about surprise medical billing that's the topic of this week's healthcare triage
we've talked about surprise medical billing more than once around here because it's awful because we want to warn as many people
as we can about it so they're not surprised surprise billing is what happens when an insured individual receives care from an out of network provider without their knowledge for example in an emergency situation and ends up receiving an outrageously high bill for it that will not be covered by their insurance this can happen even when the facility in question is in network
because physicians such as emergency
doctors and anesthesiologists in that facility may not be in the same insurance network unbeknownst to the patient so even patients who have the time and wherewithal to ensure a facility is in network during an emergency
can be hit with these bills stories serving as examples of this can be found in various media sources one that received a lot of attention was of a man who had a heart attack
in texas was rushed to the emergency room and later received a bill for over
one hundred thousand dollars after what
his insurance paid there are thousands
of stories like these though with some bills in the hundreds some in the thousands and some in the six figures
for many families any of those sums are
hard to pay is an extra expense especially when they had no idea they
were coming and it's not rare in 2014 20 percent of inpatient
admissions that began in an emergency
department and 14 of outpatient visits to the emergency department were likely to result in a surprise medical bill according to a kaiser family foundation survey eighty percent of respondents supported the banning of this practice
while two percent either refused to
answer or marked don't know we can only wonder about the motivations of the 18 percent who appear to be in favor of it some states have passed at least partial protections against surprise billing though several have not and in general most of congress has been in agreement
with banning the practice at a federal
level the pushback has come from surprise private equity firms facilities and physicians who profit from it these groups are aggressively against reform and have up until now successfully beaten back legislation that would fix the problem for consumers but that story is finally changing he no surprises act was included in the december legislation for coveted relief paired with the latest government funding bill and it goes into effect in 2022 the new legislation requires that patients only be held liable for the in-network cost-sharing amount
billed for out-of-network emergency care
or care from in-network facilities that ends up being out-of-network in cases where informed consent has not been obtained from the patient so it's just what it sounds like no more large and surprising bills for consumers that received out of network care in an emergency situation or in other situations without their informed consent
instead there's now a 30-day period during which healthcare providers and plan issuers can settle out of network claims
leaving the patient out of it if they can't come to an agreement they can utilize the independent dispute resolution process a binding arbitration process
administered by independent outsiders
with no affiliation to the providers or issuers once enacted the new rules will apply to doctors and hospitals it will also apply to air ambulances ground ambulances however will be exempt this is an interesting exemption given that over 70 percent of ambulance rides results in a surprise bill for the patient according to reporting from the new york times
lawmakers viewed this as too complicated an issue to address right now in the middle of an already complicated fight the bill does however
establish a commission to study the
ambulance issue so we may see some
changes for this exemption in the future
also a small handful of states already
include ambulances and surprise billing
legislation.
colorado approached the issue by banning surprise billing from privately funded ambulances but allowing publicly funded ambulances to continue the practice however the privately funded ambulances are now reimbursed by insurers at 325 percent of the rate that medicare pays note that medicare already banned surprise billing for ambulances and simply pays a set rate
this private fee may be higher than what
publicly funded ambulances are receiving overall especially because many of their surprise bills end up.
unpaid so there are some tricky issues
but this is huge progress after years of fighting for legislation that was already popular with most parties we'll take the win for now hey you enjoyed this episode you might enjoy.
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