On Nov. 22, a press release from the U.S. Department of Health and Human Services (HHS) announced the release of a new report highlighting that millions of Americans with private health insurance experience some kind of surprise medical billing.
The release states that “The report, which was written by researchers in HHS's Office of the Assistant Secretary for Planning and Evaluation (ASPE), found that surprise medical bills are relatively common among privately-insured patients and can average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants, and $750 for childbirth-related care. While many states have taken steps to try to address surprise billing, state laws have left critical consumer protection gaps that will be addressed when the No Surprises Act takes effect in 2022.”
That said, “Consumers often expect their employer-sponsored insurance will shield them from high out-of-pocket costs for emergency services. Unfortunately, the ASPE report reveals that an estimated 18 percent of emergency room visits by individuals with large employer coverage resulted in one or more out-of-network charges, and this percentage varies greatly by state, ranging from a low of 3 percent in Minnesota to a high of 38 percent in Texas. These costs can be quite alarming to consumers. Another finding in the report is that patients receiving a surprise bill for emergency care paid physicians more than 10 times as much as patients without a surprise bill for emergency care.”
According to the release, several states have enacted laws against surprise medical billing. The ASPE report illustrates how 18 states have comprehensive approaches to address surprise medical billing and how 15 additional states have taken partial steps.
“These efforts include establishing standard payment rates to restrict high variation for out-of-network charges and dispute resolution processes to resolve additional payments for which patients may no longer be held responsible,” the release states. “Unfortunately, despite their best efforts, state laws have significant limitations in protecting many patients from surprise medical billing. Most importantly, state insurance rules do not apply to self‐insured employee benefit plans, which cover 67 percent of workers with employer‐sponsored health coverage.”
The Biden-Harris Administration issued a series of regulations, starting January 1, 2022, that will provide patients with individual or employer health coverage relief from surprise medical billing and reduce costs. Those with most individual and employer insurance can no longer be balance-billed for emergency and certain non-emergency services in most circumstances. Additionally, patients will be removed from payment disputes that require being settled between providers and insurers. The Congressional Budget Office predicted that the No Surprises Act will reduce health insurance premiums for consumers.
The Administration released an interim final rule with comment period and is still welcoming comments on this rule.
The ASPE report can be accessed here.
