Medical marketplace takes step forward with ‘No Surprises Act’

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EYEWITNESS NEWS (WBRE/WYOU) — The American Journal of Medicine reports more than half of Americans who file for personal bankruptcy cite medical debt as the reason.

But now a leading contributor to the problem has been eliminated.

It’s scary enough to show up at a hospital needing immediate attention. But something also frightening might be what’s found in your mailbox following that treatment.

“It’s very frequent unfortunately that patients have seen these surprise charges and what’s horrible about them is the cost can be hundreds of thousands of dollars more than what patients should be paying,” said Clare Krusing, Spokeswoman, Coalition Against Surprise Medical Billing.

That’s where a new federal law called the No Surprises Act comes into play.

The act requires insurance companies to cover so-called surprise charges, which according to a Kaiser Family Foundation Study, show up in bills for one-fifth of emergency treatments and one-sixth of in-network hospitalizations.

“Surprise bills are mostly common when you make an unexpected visit to the emergency room or if you were treated unknowingly by an out-of-network specialist, anesthesiologist, assistant surgeon during an in-network inpatient hospital stay,” said Krusing.

The No Surprises Act bans surprise bills for emergency services including air ambulance rides or care provided by out-of-network providers.

It also bans bills for non-emergency services delivered by out-of-network providers like radiologists and those who Krusing already named. And it prohibits out-of-network providers from sending patients bills for excess charges beyond in-network cost-sharing.

Krusing says the No Surprises Act is more than just a major step forward to fix a medical marketplace issue for, among others, 177 million Americans with workplace health insurance.

“It’s a hope of ours that patients feel more protected and more confident and more empowered to feel that they are in control of their healthcare choices,” said Krusing.

In cases where there’s a billing dispute between a hospital, a provider and an insurance company, those parties will negotiate a final payment under the No Surprises Act.

If no agreement is reached, an independent arbiter will review the issue and determine a final payment amount.

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