New federal law bans most surprise bills from out-of-network medical providers

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New Massachusetts law improves disclosures


New federal law bans most surprise bills from out-of-network medical providers

Massachusetts legislation improves disclosures


BOSTON — As part of the recently passed federal  government funding bill, President Donald Trump signed bipartisan legislation into law that will protect millions of consumers from outrageous surprise health bills from out-of-network providers. These unfair bills come from balance billing — when out-of-network medical professionals charge you the difference between their fees and the maximum amount allowed by your insurance company.

Here in Massachusetts, the Legislature passed and Governor Baker signed An Act promoting a resilient health care system that puts patients first (S2984) into law. In combination with the federal law, this act would further protect Massachusetts consumers by requiring more advance notice of a provider’s network status to help patients make choices to avoid surprise medical bills.

In response to the president signing the surprise billing legislation and the Massachusetts Legislature passing its health care bill, Deirdre Cummings, MASSPIRG’s Legislative Director, made the following statement:

“The good news is that with the passage of the federal law, consumers will finally see an end to most ‘surprise’ medical bills. Patients usually get these unexpected, often unaffordable charges when they receive out-of-network care that they did not intentionally choose.  In fact, there’s a one in five chance that we’ll be hit with a surprise medical bill after visiting a hospital or emergency room.

“Surprise out-of-network billing predominantly occurs in two key scenarios: 1) the patient is taken to and receives emergency care at an out-of-network facility because of circumstances out of their control; or 2) the patient seeks care at an in-network facility, but during the course of treatment the patient is unexpectedly treated by an out-of-network provider. In each of these cases, the patient has done everything in their power to pursue an in-network hospital or doctor, but nevertheless is hit with a costly bill.

“When the federal law is in place,  out-of-network providers, hospitals and air ambulances won’t be able to take advantage of people who need care in an emergency or who did their best to go to an in-network provider. Instead of paying the “out of network” prices, consumers instead will pay their regular in-network amounts. The days of surprise billing are over, even from those providers who have traditionally refused to join insurance networks — anesthesiologists, radiologists and emergency room physicians.

“The federal protections will be enhanced by the notice provisions in the recently passed state healthcare bill

“Critical to solving the surprise billing problem is to ensure that not only are we protecting consumers from surprise medical bills, but to also ensure that the solutions don’t shift costs in ways that make our health care premiums soar. The federal law installs guardrails to prevent out-of-network billers from simply charging our insurance companies instead, which could increase our premiums. It sets up an arbitration system that could reduce out-of-network payments by insurers by up to 15-20 percent. But coupled with the language in the Massachusetts’ bill, we could improve the process and rates set for out-of-network procedures as it calls for state agencies to propose to lawmakers  recommendations for out-of-network rates for Massachusetts providers.

“For too long, consumers have paid an unfair and significant price because of a dispute between providers and insurers. The new federal law, combined with changes in our state law, will finally offer this long overdue protection. However, as providers and insurers work out their dispute over billing we must ensure we don’t get harmed again with higher health care premiums.”