TThe Biden administration began on Thursday to ban surprise billing practices, a step towards ending unforeseen fees charged to patients for expensive health services such as air ambulance rides.
“These latest guidelines strengthen important protections in the law for patients facing medical emergencies, including situations where notification and consent procedures would not apply so that patients do not fall victim to a surprise bill. at their most vulnerable times “, say it lobby group Coalition Against Surprise Medical Billing, which represents major healthcare professional groups, such as US Medicare Plans and the Blue Cross Blue Shield Association.
The Department of Health and Human Services announced the rule prohibiting surprise billing for non-urgent and emergency services, such as air ambulance rides, which are among the most expensive services for patients, rising often in the tens of thousands of dollars. Even if their insurance plans partially cover the cost of an air ambulance ride, patients would be responsible for covering the balance of their bill. In fact, the median price of an air ambulance service in 2017 was around $ 36,000, according to at the Government Accountability Office.
However, that $ 36,000 price tag can be much higher, as Amy Thompson of Montana learned after her baby girl had to be airlifted to Seattle Children’s Hospital 600 miles away because she suffered from heart failure, Kaiser Santé news reported. Thompson’s insurance covered the cost of her daughter’s care, with the exception of air ambulance transportation. This invoice amounted to $ 56,000.
The new rule is the Biden administration’s first step towards implementing a law signed by former President Donald Trump last winter called the No Surprises Act, which would essentially ban unexpected billing practices for most health services. By law, healthcare providers will have to negotiate payments for off-grid services with insurers without involving patients. Notably, ground ambulance services have been excluded from the law, and patients will always be vulnerable to surprise bills.
The No Surprises Act is the result of a compromise. The final product included aspects of the Dropping Healthcare Costs Act of 2019, introduced by Democratic Washington Senator Patty Murray and former Republican Senator from Tennessee Lamar Alexander. The No Surprises Act has also taken the language of arbitration from a 2019 proposal members of the House Ways and Means Committee, which has fostered voluntary negotiations between insurers and providers with independent dispute resolution as a back-up plan.
The HHS rule released on Thursday will be followed by another outlining a new arbitration process that calls on insurers and providers to enter an independent dispute resolution process to resolve the outstanding invoice. A third-party arbitrator would take the insurer and provider’s final offer payment proposals and determine the fairest price based on several factors, such as the historical median rate of the insurance plan for similar health services. .
The new rule will take effect on January 1 of next year.