Surprise medical bills for out-of-network care can cost tens of thousands of dollars. But a new law, more than a year in the making, is set to go into effect on Jan. 1 that aims to prevent those high bills.
The law, the No Surprises Act, requires providers and insurers to determine how much the doctors or hospitals should be paid. That would happen first through negotiation, and then, if they can't agree, arbitration.
However, there is still some debate over how the law will be implemented.
"Patients should not be in between the provider, the doctor or the insurance company as they wrangle through who needs to pay for this," said Dr. Donald Lloyd-Jones, the president of the American Heart Association. "If it was unexpected care that the patient received from out of network, then the patient should not be in the middle of that dispute between the doctor and the insurer."
Lloyd-Jones says he's focused on making sure the law protects patients first, not the bottom line of the providers or insurance companies.
"I think the most important aspect of this act is the independent dispute review commission, and that's really a non-interested third party that's going to adjudicate the dispute, or do a judgment of the dispute between the provider and the insurance company," Lloyd-Jones said. "And that doesn't involve the patient, right? Because the patient didn't know that they were receiving this care that was out of network at the time."
The American Medical Association and the American Hospital Association filed a lawsuit against the federal government, claiming the arbitration process favors health insurers. The lawsuit argues that regulation will push insurers to seek lower payments through arbitration.
The Congressional Budget Office said the law would likely lower payments to doctors who work in specialties where surprise billing is widespread.
