Congress ends ‘ surprise’ bills by private insurers

WASHINGTON — People with private health insurance will see the nasty shock of “surprise” medical bills virtually gone, thanks to the coronavirus compromise passed by Congress.

The charges that can run from hundreds to tens of thousands of dollars come from doctors and hospitals that are outside the network of a patient’s health insurance plan. It’s estimated that about 1 in 5 emergency visits and 1 in 6 inpatient admissions will trigger a surprise bill.

Although lawmakers of both parties long agreed that the practice amounted to abusive billing, a lobbying war between doctors and insurers had thwarted a compromise, allowing the impasse to become a symbol of dysfunction in Washington.

“This has been a profoundly distressing pocketbook issue for families for years,” said Karen Pollitz, a health insurance expert with the nonpartisan Kaiser Family Foundation. “Some of these bills are onerous, and they all strike people as completely unfair.”

The compromise would take patients and their families out of the financial crosshairs by limiting what they can be billed for out-of-network services to a fee that’s based on innetwork charges. The amount consumers pay would get counted toward their innetwork annual deductible.

Insurers and service providers would submit their billing disputes to an independent dispute resolution process, which will follow certain guidelines. The main provisions of the legislation would take effect Jan. 1, 2022.

“Generally speaking, keeping the consumer out of it and forcing the providers to be the ones to settle is a positive,” said Eagan Kemp, a policy expert with Public Citizen, a liberal advocacy group. Although states have been moving to curb surprise billing, federal action was needed because states do not have jurisdiction over large employer plans that cover tens of millions of workers and their families.

Key elements of the legislation would:

⏩ Hold patients harmless from surprise bills stemming from emergency medical care.

⏩ Protect patients admitted to an innetwork hospital for a planned procedure when an out-of-network clinician gets involved.

⏩ Generally require out-of-network service providers to give patients 72hour notice of their estimated charges.

⏩ Bar air ambulance services from sending patients surprise bills for more than the innetwork costsharing amount.