The threat of a surprise medical bill could soon be a thing of the past.
That’s because Congress passed the No Surprises Act last December and the U.S. Department of Health and Human Services (HHS) has been busy on the issue, too.
The No Surprises Act protects “patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, including by air ambulances.” The bill ensures those receiving emergency treatments — where patients often don’t have a choice as to who some of their health-care providers will be — do not face unexpected out-of-network costs.
The so-called surprise medical bills occur when out-of-network provider fees exceed what health insurance plans are willing to cover — the difference resulting in unexpected out-of-pocket expenses for patients.
Edward Longe of the American Consumer Institute in Washington, D.C., recently pointed out that between 2014 and 2017, the average surprise medical bill was estimated at between $220 and $628. The problem is more pronounced in emergency room visits and emergency surgeries as surprise bills reach an average of $19,600.
Helping the cause is a new rule issued by HHS officials. It states that all emergency services will have to be treated as in-network and providers will be required to receive patient consent before they “receive care on an out-of-network basis” and before the “provider can bill at the higher out-of-network rate.”
For consumers, the new rule could provide financial security and the confidence to receive crucial medical care. A 2019 study found “66.5 percent of all bankruptcies” in the United States “were tied to medical issues,” particularly after receiving out-of-network care.
The fear of receiving out-of-network care has forced thousands of Americans to delay receiving medical care. A study conducted in March 2020 found one in four Americans avoided medical care because of the cost, with many citing the fear of receiving a surprise medical bill. Not surprisingly, delaying medical treatment ultimately leads to poorer, and avoidable, health outcomes.
What’s more is that prohibiting surprise bills could benefit the broader economy by lowering the federal deficit. In its economic impact assessment, the Congressional Budget Office estimated that reforming surprise billing could reduce the federal deficit between $17.8 billion and $23.9 billion over 10 years.
Recognizing the seriousness of the problem, Congress and HHS were right to step in and pass important reforms that will protect patients and guarantee them the financial security and confidence they deserve when seeking medical care.