On July 1, 2021, the Biden Administration issued its interim final rule cementing into place the No Surprises Act, which was signed into law by the Trump Administration on December 27, 2020. The Act is one of the most important consumer protection measures regarding healthcare—ever. It takes effect on January 1, 2022. And in these days of so much conflict between political parties, it represents a shining example of how both parties can do “the right thing” to change America for the better.
The interim final rule of the No Surprises Act achieves a number of things clearly in the interest of healthcare consumers.
- First, the interim final rule bans surprise billing for emergency services. It doesn’t matter where those services are rendered. They must be billed at in-network rates, without prior authorization.
- Second, the interim final rule bans reaching out to patients for cost-sharing for emergency and non-emergency services beyond in-network provider rates. When a clinician or facility accepts any money from an insurer, even if that entity is out-of-network, it cannot seek further payments from patients higher than would be due if those patients were seeing in-network providers.
- Third, the interim final rule bans out-of-network charges for elements of care rendered at in-network facilities. Gone are the days when a patient might have surgery that is covered by insurance and receive a large bill from the anesthesiologist who was not “in-network.” In fact, any out-of-network charges have to be explicitly approved by patients, who can avail themselves of a complaint and arbitration process if they feel they have been overcharged.
- Fourth, the interim final rule allows patients to waive their balance-billing protections and consent to out-of-network charges through a process that will be established. Patients cannot waive their balance-billing protections in emergency situations.
The importance of this interim final rule, setting the stage as it does for the No Surprises Act to become law, cannot be overstated. Many Americans have been left bankrupt when surprise bills reached them for services provided while at in-network hospitals, receiving what they reasonably would have believed were entirely in-network services. In emergency settings, they had even less control, since they would hardly be in a position, during a heart attack or stroke, to direct their ambulance to an in-network facility. And if the nearest ER happened to be staffed by an out-of-network emergency physician, out of network radiologist and out-of-network interventional cardiologist, that could mean being left penniless.
No more. Republicans and Democrats got this done for America, ushering in, with the Transparency in Coverage Rule also taking effect, new respect for the old adage from the ancient Greek physician Hippocrates, “First, do no harm.”
-Mark Galvin, President and CEO
