by jerry on January 15, 2021
There has been a lot going on recently in the nation's political scene. One point of political drama was the most recent round of relief payments for the pandemic. Buried in the surrounding controversy is that Congress addressed surprise medical bills -- an issue so popular that it garnered bipartisan support. The legislation takes effect in 2022 and patients will be protected from what's known as balance billing in cases of emergency care and when they are unknowingly treated by an out-of-network physician. There are some caveats. For example, patients can waive their protection against surprise medical billing under certain circumstances (with enough lead time).
An interesting component of this legislation is how the bill is resolved between the provider and the insurance company. This legislation gives the problem to arbitrators, but excludes prices on either extreme from consideration: chargemaster prices (essentially "list prices"), which would favor providers, and Medicare and Medicaid rates, which would favor payers. Arbitrators can consider in-network prices, which might reduce the pressure for some payers to enroll more providers in their network.