From Tomorrow, Surprise Medical Bills Will Be Illegal In The US

Currently more than one in five Americans receive surprise medical bills for treatment they thought was covered by insurance. Image: fizkes/Shutterstock

The new year is often seen as a time for turning over new leaves. Maybe you’re planning on finally giving up smoking, or perhaps you want to reduce the amount of red meat in your diet – basically, whatever your new year’s resolution is, there’s a good chance it will involve doing something new, getting healthy, and enjoying life more.

Well apparently, that applies to the government as well. As of tomorrow, January 1, 2022, there will be a new law on the books in the USA: the No Surprises Act. Passed with bipartisan support towards the end of last year, and fine-tuned in the past 12 months, the Act outlaws surprise medical bills for nearly all emergency – as well as some routine – care.

“The No Surprises Act is really one of the biggest consumer protections to pass in recent decades,” Loren Adler, assistant director of the USC-Brookings Schaeffer Initiative for Health Policy, told CNN. “Now when patients go to the hospital for an emergency or for elective planned care, like a surgery, they no longer have to worry about getting a surprise out-of-network bill.”

This is a big move. There are few things that confuse the rest of the world more about the USA than its healthcare system: while the citizens of every other developed country in the world are guaranteed universal healthcare, Americans instead rely on a hodgepodge of private insurance companies, specialized schemes for those who meet various strict criteria, and, of course, just crossing their fingers and hoping. Even for those who can access good health coverage, the situation can still be surprisingly fraught, and insured Americans who visit the hospital – even one they've checked is covered by their plan – have more than a one in five chance of being stung with a surprise bill at the end of their stay.

“Most patients with health coverage go to in-network emergency rooms and rightly expect to be treated by in-network doctors,” said Zack Cooper, assistant professor of public health and economics at the Yale School of Public Health.

Cooper, along with colleague Fiona Scott Morton, the Theodore Nierenberg Professor of Economics at the Yale School of Management, authored an enormous 2016 study exposing the scale of the problem facing Americans in need of healthcare: the average surprise bill was a whopping $622.55 – and potentially much higher depending on the treatments required.

“This is just wrong and we must do better,” Cooper commented at the time. “People should not face financial ruin from medical bills they cannot reasonably avoid.”

Cooper and Morton’s study had a huge impact: it very quickly caught the attention of lawmakers in DC, who recruited the pair, along with other researchers and experts, to consult on the issue. Eventually, in December 2020, Congress passed a huge COVID-19 relief and government funding bill in a rare bipartisan landslide vote, including the provision against surprise medical bills, which goes into effect tomorrow.

“Engaging with lawmakers was a heavy lift, but it resulted in a policy solution that should spare people the shock and hardship of a steep and unexpected medical bill,” said Steven Berry, the Jeffrey Talpins Faculty Director at Yale's Tobin Center for Economic Policy. “We hope to build on their experience to tackle other problems in need of well-considered policy solutions.”

While the new law should protect patients from steep and unexpected bills for emergency treatment – costs will be limited to in-network levels, regardless of who treats you, per the New York Times – there are some notable exceptions. Ambulance companies will still be able to charge patients directly (though air ambulances are covered by the Act) though Congress has not ruled out the possibility of their being covered in future. And patients requiring routine care will still need to take care to choose a facility and doctor covered by their insurance – and make sure they don’t sign any forms agreeing to pay extra.

With those precautions, the NYT explains, you can’t be stung by a surprise bill – no matter who ends up actually treating you.

While a few medical groups have already brought lawsuits to challenge parts of the Act, it’s unlikely the new protections will be affected – the legal cases seek to influence a specific aspect of negotiations between hospitals and insurers rather than the meat of the Act itself. But Congress isn’t the only place where support for the new protections is broad, and key medical bodies such as the Business Group on Health and the American Heart Association have spoken out in favor of the law.

“[The current system] takes advantage of people at their most vulnerable moment,” said Patricia Kelmar, a director of health care campaigns at U.S. PIRG, talking to CNBC.

“It’s not like you’re given a bunch of offers of who you can choose as a provider,” she added. “The last thing you’re doing at that point is checking network status and asking for cost estimates.”

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