Winners, Losers Remain Unclear With Surprise Billing Fix

After years of failed attempts, Congress has finally come to an agreement on a measure to end the practice of surprise medical billing — leaving experts debating whether the new policy can slow the growing cost of health care and the inflation of premiums. The legislation is part of the Dec. 21 Consolidated Appropriations Act, a coronavirus economic relief bill that was passed by Congress but at press time faced an uncertain future after President Donald Trump on Dec. 23 condemned the bill’s $600 direct payments to Americans as too low.

Surprise billing, also known as balance billing, is the practice of charging patients for out-of-network procedures that insurers refuse to pay for in whole or in part. Often, patients incur these balance bills without their knowledge: Some patients are incapacitated when treated by an out-of-network specialist like an anesthesiologist and cannot consent to the procedure they receive. The new legislation would ban providers from sending such a bill to patients, and would instead require providers to negotiate reimbursement with the patient’s insurer or submit the dispute to a binding arbitration process. The measure would not apply retroactively.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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