Awaiting The Enactment Of The No Surprises Act On January 1


The new year will bring about a new era in the world of medicine. A big change will occur related to the ways in which patients are billed for medical services. On January 1, 2022, the No Surprises Act will come into effect. Officially known as the Consolidated Appropriations Act, 2021, the new law will eliminate surprise billing.


As the Assistant Secretary for Planning and Evaluation (ASPE) informs, surprise billing occurs when a privately-insured person receives an unexpected bill. The bill could be due to an emergency situation or when a service in an in-network facility is provided by an out-of-network provider. A top objective of the No Surprises Act is to remove the patient from disputes between payers and providers.


The No Surprises Act will put a stop to overpricing.


On AdvizeHealth.com, Michael McAuliff points out that the No Surprises Act has the potential of putting “overpriced doctors” out of business. Needless to say, it’s not right to charge astronomically large and unreasonable rates. It also isn’t fair to force patients to contact their insurance providers to figure out whether or not coverage is available for their shockingly high bills.


As McAuliff explains, “the law shields patients from those bills, requiring providers and insurers to work out how much the physicians or hospitals should be paid, first through negotiation and then, if they can’t agree, arbitration.” He goes on to note, however, that some medical professionals aren’t particularly pleased with the No Surprises Act.


Last month, Health and Human Services (HHS) announced some interim final rules.


According to doctor groups and medical associations, the rules favor insurance companies in the arbitration phase. “That’s because, although the rules tell arbiters to take many factors into account, they are instructed to start with a benchmark largely determined by insurers: the median rate negotiated for similar services among in-network providers,” notes McAuliff.


HHS Secretary Xavier Becerra sees it another way. While insurers may be given some ability to drive rates down, the bottom line is protecting patients, he says. Unfortunately, for far too long, medical providers have taken advantage of a complicated system. They have manipulated it to charge exorbitant rates. The No Surprises Act will force them to bear their share of the cost, or close if they can’t, Becerra told Kaiser Health News (KHN).


It simply isn’t right to overcharge patients.


Becerra doesn’t believe there will be a wave of closures or diminished access for consumers. He simply believes that the new law will foster a competitive, market-driven process. A new balance will be established especially when consumers know better what they are paying for.


“I don’t think when someone is overcharging, that it’s going to hurt the overcharger to now have to [accept] a fair price,” Becerra is quoted as saying in McAuliff’s article, “Those who are overcharging either have to tighten their belt and do it better, or they don’t last in the business. It’s not fair to say that we have to let someone gouge us in order for them to be in business.”


At Allegiant Experts, we have decades of experience evaluating medical bills.


In many court cases, we have helped to determine the usual and customary charges for providers in specific geographic areas and fair market value reimbursement for like providers in the same geographic areas.Maybe we can help you! Call us at 407-217-5831 or email us at info@allegiantexperts.com if you have healthcare questions. If we can’t help you, we’ll be sure to point you in the right direction!

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