The Biden administration has issued its first in a series of rules to eliminate surprise billing practices and high out-of-network cost-sharing for emergency and non-emergency healthcare services.
“No patient should forgo care for fear of surprise billing,” said Health and Human Services Secretary Xavier Becerra. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs … with this rule, Americans will get the assurance of no surprises.”
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The interim final rule will ban surprise billing for emergency services, such as air ambulance rides, as well as non-emergency health services. The rule will also ban out-of-network cost-sharing for ancillary services provided by healthcare professionals who work at in-network facilities but are not covered by the patient’s insurance. For instance, a patient undergoing surgery at an in-network hospital will not be forced to pay out-of-pocket to be put under by an anesthesiologist outside of their health plan.
The rule, which will go into effect Jan.1, 2022, is the first step in implementing the bipartisan No Surprises Act passed in late 2020 to not hold patients responsible for unexpected costs. Though Thursday’s rule is the first of several, HHS officials said they were not prepared to say how many rules will follow, but they will be announced in due time.
“We’re striving to make everything as simple, straightforward and clear, as we can so that everyone can assert their rights,” Becerra told reporters Thursday. “If we’re going to keep people from being blindsided with some of these charges, we need to make sure that it’s straightforward how everyone does this … what it is they’re expected to do and what it is they’re expected not to do.”
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One of the next rules to be announced will pertain to a new dispute resolution process in which healthcare providers and insurers will debate out-of-network charges. An independent arbitrator will then select between the final payment offers submitted by each party.
Congress has long sought to eliminate surprise billing practices, but efforts last year stalled as the pandemic worsened. The arbitration proposal within the No Surprises Act was contentious, with lobbying groups for physicians such as the American Medical Association arguing it puts physician practices still recovering from the pandemic at a disadvantage while favoring health insurance plans.