Providers see the act as yet another obstacle to collecting on unpaid medical bills.
Under the No Surprises Act passed by Congress late last year, medical groups cannot bill patients for certain services. The act essentially prohibits medical facilities for billing for non-emergency services by out-of-network providers during a visit by the patient at an in-network provider. This helps to ensure individuals are not blind-sighted by a high charge.
“This marks a big win for the American people,” an unnamed senior Health and Human Services (HHS) official said. “No one should go bankrupt over medical bills, but two-thirds of all bankruptcies filed in the United States from 2013 to 2016 are tied to medical expenses. Currently, two-thirds of adults worry about being able to afford unexpected medical bills for themselves and their families. The rule will not only allow consumers to plan for and compare costs, but also provide an avenue for consumers to dispute unexpected charges.”
Some medical groups, of course, are less than happy with the new provision, which was passed by the Biden Administration and jointly issued by the departments of HHS, Labor, and Treasury. They see it as an additional obstacle to collecting funds they believe are owed to them for healthcare services.
Gerald Harmon, MD, and president of the American Medical Association (AMA) said, “The interim final regulation ignores congressional intent and flies in the face of the Biden administration’s stated concerns about consolidation in the healthcare marketplace. It disregards the insurance industry’s role in creating the problem of surprise billing at the expense of independent physician practices whose ability to negotiate provider network contracts continues to erode.”
Harmon added, “Congress appreciated the negative consequences of national price-setting for healthcare services and spent considerable time and effort developing a robust independent dispute resolution process to maintain market balance and preserve access to care, which the administration apparently ignored. It also is apparent that the administration failed to appreciate the importance of creating accessible and impartial dispute resolution processes as a backstop against even greater insurer abuses.”
Courtney Jones, a senior case manager with the Patient Advocate Foundation, said the measure addresses, more than anything, disputes between the insurer and provider, rather than the patient. She explained, “They use it as a tactic to put some pressure on the medical facility to refund the money.” Nevertheless, it helps to protect patients who are often caught in the middle.
Stacey Hughes, executive vice president of the American Hospital Association (AHA) agreed with Harmon’s sentiments, stating, “Hospitals and health systems strongly support these protections and the balanced approach Congress chose to resolve disputes. Disappointingly, the Administration’s rule has moved away from Congressional intent and brought new life to harmful proposals that Congress deliberately rejected…[It] is a windfall for insurers. The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients. These consumer protections need to be implemented in the right way, and this misses the mark.”