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New Federal 'Surprise' Medical Bill Law May Be Tricky to Implement

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What You Need to Know

  • Many No Surprises Act provisions take effect Jan. 1, 2022.
  • The law applies mainly to enrollees in self-insured plans.
  • One worry is patient notice form overload.

The American Hospital Association (AHA) was happy to see the federal No Surprises Act become law, but implementing and applying the act could be a challenge.

Molly Smith, group vice president for public policy at the AHA, talked about the new anti-surprise billing law during a panel discussion Tuesday, at the AHIP National Health Policy Conference for 2021.

The No Surprises Act is part of the Consolidated Appropriations Act, 2021, package, which former President Donald Trump signed Dec. 27, 2020.

It includes many provisions designed to protect people from getting big bills for care from expensive, out-of-network providers at in-network hospitals, big bills from out-of-network emergency care providers, and out-of-network air ambulance services providers.

States typically impose anti-surprise billing rules on health insurers that are working with doctors and hospitals that have patients with insurance from an insurance company. States can’t regulate surprise billing at self-funded employer health plans. The new federal law will apply mainly to employers’ self-funded health plans, Smith said at the AHIP conference, which was presented through the web.

One concern is about a section of the law that requires health plans and out-of-network providers that disagree about charges for care to go through arbitration.

Smith wondered whether the arbitration process will be predictable enough to minimize the need for hospitals to spend time and money actually going through with it.

Use of arbitration has usually been low in states that already have well-established anti-surprise billing arbitration programs, Smith said.

The Jan. 1, 2022, enactment date is still another worry, Smith said. “The timeline is just so incredibly tight.”

Simply educating hospital employees about the requirements will be a big job, she said.

A third concern: Implementation of a No Surprises Act provision allowing some types of providers to offer care on an out-of-network basis if they advise the patient about the potential billing and get a signed consent form.

That kind of approach could get complicated, because “there is already just so much paperwork and communication that we’re trying to have with patients,” Smith said.

A fourth issue is how the No Surprises Act drafters came up with their definition of “surprise.”

“The reality is that that’s not how consumers define the surprise bills,” Smith said. “They define a surprise bill as any bill that gives them a surprise, whether it’s the amount on the bill or services that they weren’t expecting. There’s a whole bunch of stuff that can be very surprising about the patient billing and financial experience. That’s an area for all of us to do a lot of work on.”

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