![]() ![]() Researchers estimate that 1 of every 6 emergency room visits and inpatient hospital stays involve care from at least one out-of-network provider, resulting in surprise medical bills. Two-thirds of all bankruptcies filed in the United States are tied to medical expenses. Tackling surprise billing is critically important, as it often has devastating financial consequences for individuals and their families. These provisions will provide patients with financial peace of mind while seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate. Bans other out-of-network charges without advance notice.Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates. Bans high out-of-network cost-sharing for emergency and non-emergency services.Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization. Bans surprise billing for emergency services.The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises."Īmong other provisions, today's interim final rule: "Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs. ![]() "No patient should forgo care for fear of surprise billing," said HHS Secretary Becerra. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan's network and can happen for both emergency and non-emergency care. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued "Requirements Related to Surprise Billing Part I," an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Today, the Biden-Harris Administration, through the U.S. Announcement is the first in a series of regulations aimed at shielding patients from increased financial hardships stemming from surprise medical bills ![]()
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