A year ago, the United States reached a tipping point in healthcare transparency. New laws have been enacted aimed at avoiding unnecessary and unexpected health care costs. After January 1, 2022, healthcare providers and insurers will no longer be allowed to pay bills for out-of-network services privately to insured persons.
Experts say the bipartisan no-surprise law was a rare victory for patients and the public against exploitative healthcare costs, but challenges remain.
In 2019, Republicans and Democrats in Congress worked together to create a bill that eventually became the No Surprise Act.of the law protects Group and individual health insurance plans suffer from receiving unexpected bills from out-of-network providers who cared for them at in-network facilities. After that, I was able to understand the scope of coverage and costs.
read more: The startling medical cost ban fails to cover some key factors.Here’s what you need to know
Before former President Donald Trump signed the bill into law in December 2020, people were able to receive treatment and recover from devastating accidents, but the resulting health care debt kept their finances from collapsing. I just watched. more than half of Americans In 2018, he said he encountered some version of this outcome when trying to get care, and research found that Fear of medical debt Historically, it has discouraged people from getting the care they need.
Surprise medical bills of many kinds are now illegal, presumably alleviating a major concern that plagues millions of Americans.
Even before the law went into effect, few Americans reported having trouble paying their medical bills, according to federal data released this week.
By 2021, nearly 11% of people in the United States will have lived in a household that had had trouble paying their medical bills in the past 12 months, according to an analysis by the Centers for Disease Control and Prevention of the National Health Interview Survey. said. This is down from 14% in 2019, down from 10.5 million people who said they were suffering from medical debt.
However, the authors say medical debt remains “a major contributor to overall US debt.”
Here’s what the law has and hasn’t done so far, health policy experts and advocates told PBS NewsHour.
“Change business model”
compared to other countries, Rising healthcare costs in the US have left patients behind Less results, more debt.
According to a 2018 analysis by a team of health economists: Yale University, the medical system held all cards and patients basically had to gamble when receiving treatment in hospitals in the United States. may have been admitted to an in-network hospital, but had a fracture treated by an out-of-network doctor. Patients were set for an “impossible task,” and there was virtually no way to scrutinize the care team or prevent lapses until the bill was received, said he, the leader of the USC-Brookings Schaeffer Initiative for Health Policy. says Loren Adler.
Nearly a decade ago, a woman shared her “Typical American Healthcare Story” with Caitlin Donovan, spokesperson for the National Patient Advocacy Foundation. The woman gave birth to twins and was treated in the NICU ward of a hospital in the network, Donovan told PBS Newshour. I had checked (and it was covered by insurance), but I didn’t know that the administrator had outsourced the NICU ward staff. She didn’t know until her insurance billed her for $30,000 to care for her child.
look: The startling medical cost ban fails to cover some key factors.Here’s what you need to know
Stories of this sort embodied the concerns found among two-thirds of Americans. 2020 Survey by Kaiser Family Foundation.
Multiple Private Equity Firms Spin Off Ahead of Tighter Regulation Favorable practice It used out-of-network services from tens of thousands of doctors to staff hospitals, including emergency departments. As the 2018 Yale Report noted, “Overall, the ED [emergency department] Although the profit margin depends on various factors. The end result of these private his equity practices were patients who ended up in medical emergencies caught in a system that Adler described as “ridiculously unfair.”
By making these practices illegal, the new law “succeeded in weeding out the vast majority of unforeseen, off-network charges from patients,” Adler said. I thought the order should be like this, so don’t think twice.”
“It’s changing the business model,” he said.
Hospital and health insurance company dispute bill
Through this law, legislators can Independent dispute resolution process Providers and payers can challenge decisions about what is covered and what must be paid out-of-pocket.
But so far, providers have “done a lot more. [appeal] Donovan said. In fact, they are challenging so many bills that they are clogging the system and pushing the Biden administration to raise the administrative costs of the process.
In late December, the Treasury Department and the Department of Health and Human Services increased the dispute resolution fee from $50 to $350 per party per contested claim as an industry deterrent. The change took effect for issues that began on or after January 1, 2023, and was due in part to “increased spending on the implementation” of the federal dispute resolution process.
The cost of ground ambulance services remains high
One area that still catches millions of Americans by surprise each year, despite the law, is the rising cost of outpatient care. Advanced life support care provided by privately insured patient ground ambulances, a non-profit medical institution, increased by 56% in three years. fair health Noted in February. According to their analysis, the average cost of some emergency ground medical care he increased to nearly $1,300.
read more: Rural ambulance services are in crisis as volunteers age and costs rise
Adler said the No Surprise Act didn’t solve these problems because they “created more thorny political problems.” In the United States, ground ambulance services are highly decentralized. In some communities, local fire departments are responsible for providing this care. In some countries, local government officials outsource their services to private companies.
Due to the patchy nature of the way services are delivered, patients often find themselves stressed with their bills while recovering from a health emergency. That forces people to make choices that can put themselves and others at risk, Donovan said.
“I have patients calling Uber to go to the hospital,” she said. “It’s not fair to anyone involved.”
