The “No Surprises Act” Medical Legislation Is NecessaryWhile Congress was negotiating what type of stimulus package to pass, consideration was given to legislation that aims to stop surprise medical bills. Lawmakers appeared to have agreed to the passage of a new law called the No Surprises Act, but the passage of the Act stalled due to the failure to pass the stimulus package.

According to Slate, the aim of the legislation was to address the surprise (and often predatory) bills that consumers receive for their medical care. The supporters of the legislation included various healthcare and consumer agreements. Many health care providers oppose the legislation.

What are surprise medical bills?

Surprise billing happens when you go for covered medical treatment at an in-network hospital, only to discover that there is a charge for medical services from an out-of-network physician. These surprise bills often occur when you visit an emergency room. Unlike pre-planned hospital care, patients who receive ER care don’t have any say about which doctors, such as ER physicians, anesthesiologists or radiologists, treat them.

While states have tried to address the problem, it’s generally thought that federal legislation is needed to provide an appropriate fix. The reason, according to Slate, that surprise billing exists is because many physicians use it “as a threat to gain leverage in negotiations over reimbursement rates with insurers. (If Humana or Aetna refused to pay the rate they demanded, they could just bill patients directly.)” The practice of surprise billing is supported by physician staffing companies, who often play a part in running in hospital ERs, and is also supported by private equity firms.

Many personal injury victims (for example, car accidents and slip and fall accidents) require emergency medical care. The aim of the legislation is for the insurance carrier and the health provider to be unable to hold the patient hostage to their dispute about the appropriate fees.

What does the new legislation provide?

If passed, the No Surprises Act will help protect consumers from catastrophic costs while giving insurance companies more leverage in settling disputes. Per Health Affairs, “[p]atients who see an out-of-network provider will not be responsible for cost sharing other than what they would have paid to an in-network provider. Equally important, providers will be barred from holding patients liable for higher amounts.”

Both emergency and non-emergency care would be subject to the No Surprises Act. It would cover air ambulances, though not ground ambulances, as well as “nonemergency services provided at an in-network facility but by an out-of-network provider.” The patient can choose to waive the protections for elective out-of-network care.

Insurers will also work to resolve payments to out-of-network providers on their own, instead of through the establishment of “benchmark payment standards.” If an agreement can’t be reached, the dispute will be submitted to arbitration. This change, from benchmark to arbitration, favors healthcare providers. There are safeguards, though, to help ensure the arbitration process isn’t abused.

This is comprehensive legislation, and like most laws, it isn’t perfect – but it’s a good start. Mezrano Law Firm supports the end of surprise medical billing, because we will always fight for what is best for our community. To speak with a strong advocate, call us at 205.206.6300 or fill out our contact form to schedule an appointment. Our offices are in Birmingham, Tuscaloosa, Mobile, Montgomery, Florence, and Gadsden.