One of the more uniquely American nightmares is not only surviving a life-threatening illness, disease, or accident, but surviving only to wake up to an enormous medical bill. Sometimes these bills aren’t even the result of an unlikely freak accident, either; sometimes you think you’re going for routine blood work or getting a check-up, and all of a sudden, you’re surprised to open your mail and see a huge bill because one part of your treatment was actually out of network, or your insurance didn’t cover what you expected it to.
This phenomenon is so common—and so problematic—in the United States that Congress actually passed a bipartisan bill, the No Surprises Act (NSA), to help protect patients, as covered by NPR. The legislation would go into effect on Jan. 1, 2022, and is a considerable win for all patients (also referred to as consumers in coverage, which is telling in itself). As reported by USA Today, however, some hospitals and organizations are pushing to delay the start date, arguing that insurers misinterpreted the guideline to get themselves better rates.
First, some background on what the NSA actually involves for patients, and how it could play out it in your own life. In short, the NSA creates federal protections for patients who receive medical care that’s actually out-of-network, whether it’s an out-of-network physician, hospital, or vendor they did not choose.
For example, this is an unfortunately common occurrence when people go to emergency rooms and urgent care centers, as well as providers a patient didn’t choose, like an anesthesiologist for a surgery or even surgical assistants. Hospitals need these workers, obviously, so they accept their terms—but then patients end up with these surprise (and often enormous) bills. The NSA will, ideally, mandate that private health insurance plans cover out-of-network claims and simply apply in-network cost-sharing.
The law also applies to air ambulance transportation, though not ground ambulance transportation. The NSA also requires that post-emergency stabilization services are covered; so, for example, treatment at a hospital after being admitted from the emergency room, at least until a physician determines it is safe for the patient to transfer to an in-network facility without needing emergency transportation services.
Importantly, the NSA also applies to non-emergency services provided to patients by out-of-network physicians at in-network facilities. This goes back to the anesthesiologist reference before. For example: A physician might provide you care at a hospital or facility, but it doesn’t mean they actually work for the facility you’re being treated at. They might work and bill independently, which is how people end up with a separate bill that doesn’t necessarily correlate with the same insurance networks.
Now, back to the push to delay it going into effect. On Dec. 9, the American Medical Association (long as several other groups) sued the federal government to stop the arbitration rules from going into effect next month. The lawsuit argues that insurance providers will try to get an “unfairly low rate” and their efforts to save money will end up being a “detriment” to patients. Basically, they’re arguing that the rule will give insurers all the power, and physicians will be pressed into accepting lower rates for their work. This could theoretically cause big issues for physicians and clinics that serve in areas with few providers, to begin with; if insurers end their contracts, patients could find themselves having to travel further for care, for example.
Imagine if everything about our health care system didn’t revolve around money? As always, every step to protect patients is a step in the right direction, but what we really, ultimately need is Medicare for All.
This phenomenon is so common—and so problematic—in the United States that Congress actually passed a bipartisan bill, the No Surprises Act (NSA), to help protect patients, as covered by NPR. The legislation would go into effect on Jan. 1, 2022, and is a considerable win for all patients (also referred to as consumers in coverage, which is telling in itself). As reported by USA Today, however, some hospitals and organizations are pushing to delay the start date, arguing that insurers misinterpreted the guideline to get themselves better rates.
First, some background on what the NSA actually involves for patients, and how it could play out it in your own life. In short, the NSA creates federal protections for patients who receive medical care that’s actually out-of-network, whether it’s an out-of-network physician, hospital, or vendor they did not choose.
For example, this is an unfortunately common occurrence when people go to emergency rooms and urgent care centers, as well as providers a patient didn’t choose, like an anesthesiologist for a surgery or even surgical assistants. Hospitals need these workers, obviously, so they accept their terms—but then patients end up with these surprise (and often enormous) bills. The NSA will, ideally, mandate that private health insurance plans cover out-of-network claims and simply apply in-network cost-sharing.
The law also applies to air ambulance transportation, though not ground ambulance transportation. The NSA also requires that post-emergency stabilization services are covered; so, for example, treatment at a hospital after being admitted from the emergency room, at least until a physician determines it is safe for the patient to transfer to an in-network facility without needing emergency transportation services.
Importantly, the NSA also applies to non-emergency services provided to patients by out-of-network physicians at in-network facilities. This goes back to the anesthesiologist reference before. For example: A physician might provide you care at a hospital or facility, but it doesn’t mean they actually work for the facility you’re being treated at. They might work and bill independently, which is how people end up with a separate bill that doesn’t necessarily correlate with the same insurance networks.
Now, back to the push to delay it going into effect. On Dec. 9, the American Medical Association (long as several other groups) sued the federal government to stop the arbitration rules from going into effect next month. The lawsuit argues that insurance providers will try to get an “unfairly low rate” and their efforts to save money will end up being a “detriment” to patients. Basically, they’re arguing that the rule will give insurers all the power, and physicians will be pressed into accepting lower rates for their work. This could theoretically cause big issues for physicians and clinics that serve in areas with few providers, to begin with; if insurers end their contracts, patients could find themselves having to travel further for care, for example.
Imagine if everything about our health care system didn’t revolve around money? As always, every step to protect patients is a step in the right direction, but what we really, ultimately need is Medicare for All.