Director, Health Care Campaigns, PIRG
Director, Health Care Campaigns, PIRG
Feds divulge first set of details to states on pending law
WASHINGTON — Six months before the No Surprises Act takes full effect, four government agencies that will administer the new medical billing law — the Office of Personnel Management and the Departments of the Treasury, Labor and Health and Human Services (HHS) — released interim final regulations late Thursday.
“Americans are looking forward to a brighter future, after years of the dark clouds of surprise medical bills looming over them,” said Patricia Kelmar, U.S. PIRG Health Care Director. “These interim regulations are the first step to ensuring effective implementation of important consumer protections to give patients peace of mind that come January 1, they won’t receive any more expensive out-of-network bills.”
Former President Donald Trump signed the No Surprises Act on Dec. 27, 2020. This law will eventually prevent out-of-network providers from sending surprise bills to patients seeking emergency room care or non-emergency care at in-network hospitals. Patients who go to an emergency room or have surgery have a 1 in 5 chance of receiving an out-of-network bill they didn’t expect and may not be able to afford. The No Surprises Act will ban most of these “surprise bills” and keep consumers out of the middle of payment disputes.
The first set of regulations unveiled Thursday deal primarily with how to calculate what consumers will have to pay for out-of-network care; how plans and providers will give consumers information about their new surprise billing protections; and when and how out-of-network providers can ask patients to waive these protections. The government also released model forms that providers and hospitals have to use. They include a standard patient disclosure notice about surprise billing protections as well as a notice and consent document to be used when patients are asked to waive their protections. If out-of-network providers do not use these forms or republish them verbatim, they may not be in compliance with the new law.
“We’re gratified the rules clarify that surprise billing protections apply to out-of-network bills not just from hospitals but also ambulatory surgeries centers, where close to 60 percent of surgeries occur today. We’re also glad that consumers can read about their protections in their explanation of benefits and on documents the Act requires providers to post in their offices,” said Kelmar. “However, the rules should more strongly and clearly prohibit providers from sending patients any balance bill. The goal of the No Surprises Act was to keep payment disputes between providers and insurance companies. To ensure the best protection from surprise bills, our health plans should be managing the flow of billing and a consumer should never see a bill directly from a provider.”
U.S. PIRG was instrumental in passing several state laws that led to the federal solution and was active in the Congressional battle against private-equity backed opponents of the Act. Since then, the nonprofit advocacy group has been educating consumers about their rights. On June 24, U.S. PIRG delivered signatures from more than 5,600 concerned Americans to HHS Secretary Xavier Becerra asking that the rules “close the loopholes” and “give the states clear enforcement power to stop providers from sending these unfair and expensive bills.” The nonprofit has also been monitoring the Act’s provisions that allow a provider to ask a patient to waive their protections under the law and agree to pay additional out-of-network costs. Kelmar says on that count, the interim rules fall short and open a wide loophole.
“We are very concerned that the rules allow providers to ask patients to waive their surprise billing protections within 72 hours of treatment and up to three hours before a procedure.That’s just not enough time for patients — some of whom may already be in backless gowns in a hospital room — to find alternative in-network care. They’ll feel forced to sign the consent form and open themselves to expensive bills!” she concluded.