Surprise Medical Billing Fix

The surprise Medical Billing fix has been included in the Covid-19 relief deal, which would protect patients from receiving large medical bills from out of network providers.

The bill calls for patients to be held harmless in emergencies where they have no control over where they receive medical services, especially when it comes to ambulance services. The patient will still be required to pay for out of network services, but those charges must be reasonable.

Health Insurers and providers will have to negotiate the out of network medical charges or bring the issue to a mediator. The law would forbid insurers from using Medicare reimbursement rates as the benchmark and bars providers from using their billed charges as the benchmark. The new system will take place in 2022.

For Hoosiers, surprise medical billing has been a real issue. Very few ambulance services participate in any insurance network, which has resulted in surprise medical bills. We have also seen on multiple occasions where the anesthesiologist is not in the insurance company’s network. The patient has little to no say on who performs the anesthesiology during a procedure.

Then there is the latest trend of emergency physicians not participating in a carrier network even though they appear to be employees of the hospital group. All the situations have led to Hoosiers receiving surprise medical bills outside of the health plan.

It is important to remember that even with the new Medical Bill fix, a patient may have satisfied their in-network deductible but the out of network claims go to a separate deductible. The patient could still have a financial burden, but now at least it’s one that is manageable.

In 2022 it will be interesting to see how the arbitration pans out. This could lead to more health care cost transparency in Indiana and the rest of the country.

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