At the beginning of 2021, the Allegiant Experts Blog happily passed along the good news set for the beginning of 2022. It revealed that when the calendar flips over, on the first of January, surprise medical bills will officially become a thing of the past. As our blog from this past January explained, on December 27, 2020, the No Surprises Act was passed and signed into law.
“As announced by the U.S. Senate Committee On Health, Education, Labor & Pensions, the bipartisan, bicameral agreement protects patients from surprise medical bills,” we reported, “It also establishes a fair payment dispute resolution process.”
The No Surprises Act is set to take effect on its targeted date.
As reported by Ricardo Alonso-Zaldivar of the Associated Press, courtesy of USNews.com, the U.S. government is currently putting the finishing touches on the bill. It seeks to prevent insured patients from being hit with surprise charges during their most vulnerable moments.
“Patients will no longer have to worry about getting a huge bill following a medical crisis if the closest hospital emergency room happened to have been outside their insurance plan’s provider network,” writes Alonso-Zaldivar, “They’ll also be protected from unexpected charges if an out-of-network clinician takes part in a surgery or procedure conducted at an in-network hospital. In such situations, patients will be liable only for their in-network cost sharing amount.”
The new rules are finally being spelled out.
When 2022 gets underway, there will be a new system set in place. It involves a behind-the-scenes dispute resolution process. Hospitals, doctors and insurers will have to use the system to figure out their fees, leaving the patients completely out of it. Insurers and service providers may disagree about what constitutes as fair payments. Both sides are given the opportunity to initiate a 30-day negotiation process. If no agreement is made within that time, the matter is then taken to an independent arbitrator.
“The arbitrator will use as a guide a set amount intended to balance the value of the medical services provided with goal of keeping costs from ballooning out of control,” Alonso-Zaldivar explains, “Clear justification will be required for the final payment to end up higher or lower. There will also be a new way for uninsured people and patients who pay their own way to get an estimate of charges for medical procedures, as well as a process for them to resolve billing disputes.”
Surprise medical bills have been a common problem for too long.
The law’s new protections will include more than just protecting patients from surprise bills arising from emergency medical care. They will also protect patients who are admitted to in-network hospitals for planned procedures when out-of-network clinicians get involved and submit bills. Air ambulance services will also be banned from sending patients surprise bills for more than the in-network cost sharing amounts.
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.
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