The No Surprises Act comes with some surprises

Today’s edition: A message about abortion politics from Ohio. Details of the latest data broker accused of tracking patient visits to reproductive health clinics. But first…

No-surprise laws have protected many patients from paying high hospital bills. However, surprise bills arrive one after another.

Surprise Prohibition Law, a landmark law aimed at protecting patients from unexpected out-of-network medical bills, came with, well, a few surprises. More than two years after it came into force, there is good news and bad news about its effectiveness.

First, it is important to note that this law has been successful in protecting millions of patients from surprise bills. This could be something like an out-of-network emergency ambulance ride or a patient experiencing symptoms and being treated by an out-of-network anesthesiologist or emergency room physician. Any attempt to stay on the network.

Most Americans have a health insurance plan with a network of doctors and hospitals. When you stay in-network, you typically only pay deductibles, copays, and other cost-sharing costs. But whether you intentionally or inadvertently go outside your network, you can end up with a hefty medical bill.

about 22 percent emergency visit In 2015, surprise charges against out-of-network doctors occurred. Anti-surprise laws limit the amount that can be charged to patients for these services. This is a huge benefit for consumers.

But behind the scenes, the new law is causing further disruption to an already chaotic system.. Some politicians wanted the law to require out-of-network emergency care providers to accept in-network payment rates. Instead, the law requires insurance companies and out-of-network providers to negotiate fair payments that both parties agree to.

Here are the pitfalls: If the two sides cannot reach an agreement, the law allows either side to seek baseball-style arbitration (officially called “arbitration”). Federal independent dispute resolutionor via IDR) government-certified arbitrator To determine fair pay.

There are only about 800 Major League Baseball Many players only negotiate new contracts every few years. There is almost 50,000 ER doctor and north 40,000 Anesthesiologists – These are the two most common specialties for unexpected charges for physicians.

Government officials are 22,000 They underestimated providers’ anger by an order of magnitude. 490,000 IDR requests will be submitted until June 2023. This represents a huge backlog for an underfunded system. 61 percent As of December 2023, it remained unresolved. Government Accountability Office report found.

“It’s great that patients aren’t getting surprise bills, but it’s also clear that this has become an administrative hassle,” he said. zach cooper, yale university He is a health economist who studies the surprise billing problem.

Some companies have prospered by issuing surprise invoices. It was part of the business model.Perhaps it’s not surprising that 46 percent number of requests That’s because the baseball-style arbitration came from a physician staffing company that was wholly or partially owned by a private equity firm.

In one company, Envisioning healthcare, I got angry Since doctors can no longer make surprise claims. another, team healthsaw Fitch Debt decline rating Part of the reason is because of surprise claim limitations and arbitration costs.

So what happens now for patients caught in the middle as insurance companies and surprise billers battle over who should pay?

In October 2022, the Surprise Prohibition Act will take effect. Elise Greenblatt she got what she thought was a surprise $660 invoice For telemedicine visits by out-of-network physicians at in-network hospitals. Mount Sinai Health System New York City argued that the bill was legitimate. her insurance company, empire blue cross blue shield, refused to pay, saying it wasn’t. Neither side backed down.

Because the case was not submitted to arbitration, the parties were left with no compensation. 400 dollars to 800 dollarsAnd a year later she was still receiving the bill. surprise!

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From the reporter’s notes

Becerra collects abortion stories from Ohio

Our colleague Dan Diamond sent this to us from his trip to Ohio this week.

COLUMBUS — A sign in the yarn store’s window reads, “Abortion is medical care,” a deliberate rebuke to Republicans who control the state Capitol a block away and are trying to crack down on abortion procedures.

“I am simply demonstrating our values ​​to the members of Congress who decide to resign.” [the] On the street during my lunch break.” kelly freeman — co-owner of dye mud yarn A former abortion rights organizer as she and her team spread yarn on the floor, twisting and labeling skeins that had been dried days earlier.

• “the personal is politicalShe added, wearing a hat that read “Abortion Forever” and gesturing to a box of emergency contraceptives on the store counter. The emergency contraceptive pill is being provided free of charge by local organizations.

Abortion politics is roiling Ohio.the state. dominated by republicans However, it lost on this issue late last year. Voters in November decisively passed a constitutional amendment guaranteeing access to abortion, emboldening national Democrats who see abortion as their party’s top issue heading into this year’s election.

Abortion politics also helped lead Health and Human Services Secretary Xavier Becerra to visit Ohio on Monday. The country’s top health officials traveled to Columbus to wrestle with the Biden administration’s agenda, touting efforts to protect access to medication abortions and emergency abortions in hospitals, but also touting “power dynamics” surrounding reproductive health. We also solicited case studies that we hope will be useful for “changes.”

“I need to come back to Washington, D.C., with a story, a real story,” Becerra said during a roundtable with community leaders, adding that he has since the Supreme Court struck down the constitutional right to abortion in 2022. , about how America has changed. Today I have more rights than my wife. ”

One story shared with Becerra — What the health secretary said he remembers most — Provided by Daniel TongManaging Director of Celebrate Onethe city’s efforts to reduce infant and maternal mortality.

Tong suffered a uterine rupture at 29 weeks old, causing profuse bleeding, which was initially overlooked by doctors. After her emergency surgery, she survived and so did her son, who ended up spending nine weeks in the NICU.

• “I survived with a little bit of luck and the privilege of having a husband who is a cardiologist,” Tong told me, understanding that as a Black woman, many other patients are not so lucky. He added that there is. “If I had been sent home, I would have died.”

Becerra said Tong’s story “really touches my heart.” Because it shows the importance of prompt and life-saving reproductive health care.

“How do we make sure everyone gets the care they need?” The Health Secretary told me that was becoming increasingly difficult to achieve following the Supreme Court decision. . Some doctors complain that the state’s new abortion restrictions have complicated their ability to quickly provide lifesaving reproductive care.

Department of Health Secretary Xavier Becerra:

Wyden: Brokers collect and sell location data for anti-abortion ads

A software company allegedly collected location data of people who visited 600 planned parenting According to the senator’s investigation, this information was located in 48 states and was subsequently provided to anti-abortion groups. Ron Wyden (D, me.)

in letter Sent yesterday, Wyden demanded: Federal Trade Commission secure quasi-intelligence agency Delete all location and device data collected about Americans. he also securities and exchange commission This was to investigate whether the company had made misleading statements to investors.

• An SEC spokesperson told The Health 202 that they would respond directly to Wyden, while FTC officials acknowledged receiving the letter but had no further comment.

Key context: Wyden launched an investigation into the company last year after the incident. wall street journal report that of veritas association used location data from Near to target anti-abortion messages and ads to people who visited reproductive health clinics.

The advertising blitz lasted from 2019 until the end of 2022, but the scale of the campaign was unknown until yesterday. Privacy concerns have increased since the Supreme Court turned over Roe vs. Wadereproductive rights advocates have warned that sensitive data collected and sold by technology companies could be used to: Supporting abortion-related prosecutions.

In other news from the Senate…

the senate passed $95 billion Yesterday, a national security package to support Israel, Ukraine and other US allies included several provisions aimed at curbing the flow of illicit fentanyl.

If you sign the law, invoice This would allow the president to impose sanctions on international drug trafficking organizations, increase law enforcement spending, and secure additional resources by declaring fentanyl trafficking a national emergency.passed the senate 70-29after twenty two Republicans joined Democrats in approving the aid.

Reality check: speaker of the house mike johnson (R-LA) is already rejected the billThe Washington Post said Monday night that the package won’t get a start in the House because it fails to address U.S. border security. liz goodwin.

• On our radar: Lawmakers are considering increase Medicare pay Future government funding packages will provide support for doctors, but the policy will only be partially offset. 3.4 percent We saw provider cuts earlier this year, Rachel Coles report of status.
• Secretary of Defense Lloyd Austin released Since his last hospitalization last nightThe Post reported that he has had a difficult recovery from prostate cancer, including surgery in December and an extended stay in intensive care in January. Dan Lamott report
• food and drug administration letter sent Two online vendors warned to stop selling unapproved and misbranded versions of semaglutide and tirzepatidethe active ingredient used in popular diabetes and weight loss drugs such as Ozempic and Munjaro.

U.S. hospitals see post-pandemic recovery behind health care costs for insurers (Sriparna Roy and Bhanvi Satija | Reuters)

Restoring retirement benefits and health insurance signals a shift in DOL priorities (Austin R. Ramsey | Bloomberg Law)

Aggressive fungus causes meningitis outbreak linked to Mexican clinic (by Sabrina Marhi | The Washington Post)

As something that melts the hearts of my colleagues at KFF Health News. #HealthPolicy Valentine. This season, readers were surprised with poems about prescription drug pricing, medical debt, lack of primary care, and more.here it is Grand prize winners and runners-upStaff illustrators turn each work into a manga Oona Tempest.