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Regulations being set for law on surprise medical billing

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Posted at 5:11 PM, Jul 01, 2021

An estimated one in five patients receives a surprise medical bill after surgery or a visit to the emergency room.

The No Surprises Act signed into law back in December aims to prevent patients from getting surprise medical bills in most cases when they're receiving out-of-network care. But the details of the law are still being worked out.

The first set of regulations for how it will be worked out are expected as soon as this week.

“The key things that we're looking for is first of all, to make sure that the consent provisions that basically waive all of those consumer protections are written in a way that consumers aren't unknowingly signing away their protections,” said Patricia Kelmar, Health Care Campaigns Director at U.S. PIRG.

Kelmar is following the regulation process. The U.S. PIRG is concerned about loopholes and state regulators not having clear enforcement power to stop surprise billing.

“If consumer consent language is not readable, if it varies from hospital to hospital and it gets put into a stack with many other consent forms that you might be signing, that's not what was intended by Congress when they passed the no surprises protections and that's what we want to make sure the regulators understand and clearly lay out,” said Kelmar.

Something else consumer advocates are pushing for is an arbitration system that won't inflate health care costs.

Under the law, if providers and insurers can't agree on a reimbursement amount, the issue can go to an independent arbitrator.

Air ambulances are included in the ban on surprise medical bills, while ground ambulances aren't.

But the law did set up an advisory committee to make some recommendations for protections, which some states currently offer.

But the high costs are leading some people to sign up for ambulance subscriptions.

This is really best for someone with a condition where they'd need an ambulance regularly. And you have to make sure the ambulance that arrives is from the company you subscribe to.

The surprise medical billing changes are set to take effect in January.