A new law that bars medical bills sent from doctors not chosen by patients and who are outside their insurance network is set to go into effect on Saturday.
The Trump-era legislation that was tweaked this year after President Joe Biden took office is being hailed as a major new protection for consumers and one that spans “nearly all emergency medical services, and most routine care,” The New York Times reported, adding that ground ambulance services can still bill patients for their services.
“I think this is so pro-consumer, it’s so pro-patient — and its effect will eventually be felt by literally everybody who interacts with a health care system,” said Senator Bill Cassidy, a Republican from Louisiana and a physician who helped craft the bipartisan legislation, adding that he sees it as a top accomplishment during his time in Congress.
Even though many patients have health insurance, emergency care often gets expensive; patients often have high deductibles and thus are in sticker shock when bills come rolling in. However, the new law eliminates an out-of-network hospital or doctor sending a bill for care, though it’s not clear how they will be reimbursed moving forward.
“This is such an important consumer victory because it is going to protect consumers from an egregious and pervasive billing practice that has just grown over the years,” Patricia Kelmar, the healthcare campaigns director at the consumer group U.S. PIRG, told the Times.
The paper added: “Behind the scenes, medical providers are still fighting with regulators over how they will be paid when they provide out-of-network care. But those disputes will not interfere with the law’s key consumer protections.”
According to the new law, patients who have to go to an emergency room or an urgent care clinic cannot be charged more than the cost-sharing they are already accustomed to for in-network services. “This is where the law’s protections are the simplest and the most clear for people with health insurance,” the Times noted.
But patients will continue to be responsible for deductibles and co-payments, as normal. However, once a patient settled those bills, they shouldn’t expect to be sent anymore.
“We shouldn’t have to depend on people knowing minutia about insurance regulation in order for them to get care or not be unfairly billed,” noted Anthony Wright, the executive director of Health Access California. His patient-rights group supported the federal legislation and fought for a similar measure in California that barred surprise bills beginning in 2017.
The Times said that a number of studies found that about 20 percent of all Americans faced with emergency care are treated by an out-of-network provider or facility, including E.R. doctors, labs, and radiologists. Those providers could, and often did, send out extra bills for their services, but now those will be illegal as of Jan. 1.
There is a notable exception, though: Ground EMS/ambulance services, though the law does have some protections for air ambulances.
“Ground ambulances were left out of the recent legislation because legislators determined they would need a different regulatory approach. Congress established a commission to study the issue and may consider reforms,” The Times reported, adding that 11 states currently bar ground ambulance services from sending out-of-network bills.
Jon has over 30 years' worth of reporting experience, as well as an author and U.S. Army veteran. He has a BA in political science from Ashford University and an MA in national security studies/intelligence analysis from American Military University.
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