Protection against surprise medical bills becomes law [The Advocate, Baton Rouge, La.]

Advocate, The (Baton Rouge, LA)

Jan. 4—Health insurance companies practice of charging extra for people needing "out-of-network" emergency treatment was ended on New Year's Day by legislation Republican U.S. Sen. Bill Cassidy helped pass with a Democratic colleague whose seat has been targeted by the national GOP in the 2022 elections.

Called the "No Surprises Act," the new law ends the so-called "surprise medical bill" by forbidding insurers from making a patient pay the difference between what an "out of network" provider or facility charges and what the patient's insurance plan pays. Insurance companies press their customers to use only those physicians and facilities that have agreed to pay lower, in-network costs for medical services.

These surprise bills, which can run into the thousands of dollars, most often pop-up when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Sometimes even when receiving planned care, the patient inadvertently is treated by a physician, such as an anesthesiologist or radiologist, who isn't part of the insurer's network.

The Peterson Center on Healthcare and Kaiser Family Foundation, independent groups studying healthcare issues, found in a recent survey that four of every 10 insured, nonelderly adults say they have received an unexpected medical bill in the past 12 months. Of those who received an unexpected bill, half say the amount they were expected to pay was less than $500 overall while 13 percent say the unexpected costs were $2,000 or more, according to the Peterson-KFF Health Tracker.

Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits.

Users of Medicare, Medicaid and Veterans Affairs Health Care or TRICARE already are protected from surprise medical billing.

"Too often patients have been blindsided by surprise medical bills, sometimes for tens of thousands of dollars. This is a victory for them," said Cassidy, a Republican who once practiced gastroenterology medicine at the former charity hospital in Baton Rouge.

Cassidy teamed up with U.S. Sen. Maggie Hassan, D-New Hampshire, on the legislation passed as part of the December 2020 government funding bill.

"After a harrowing emergency, countless Granite Staters and families across the country have returned home only to be saddled with an unfair medical bill — sometimes to the tune of tens of thousands of dollars — because an 'out-of-network' doctor treated them," Hassan said in a statement. She had been a lawyer for one of Harvard Medical Schools' teaching hospitals.

The measure became law on Jan. 1 after the U.S. Department of Health and Hospitals finished drafting the necessary operating regulations. A lawsuit filed by the American Hospital Association and the American Medical Association, trade groups that represent hospitals and physicians, is still pending and could disrupt the future of the "No Surprises Act," though it's the law of the land now.

Hassan is viewed as one the more vulnerable Democratic members of an upper chamber that has split 50-50 along party lines. Democrats control the Senate because Vice President Kamala Harris can cast the deciding vote in case of a tie.

Twenty of the 34 seats up for election in the 2022 midterms later this year are held by Republicans. The GOP have focused on flipping four seats in the competitive races of Arizona, Georgia, Nevada, and New Hampshire.

In December, Bobby Jindal's political action committee — America Next — spent $1.18 million during college football games on television commercials blasting Hassan's support President Joe Biden's $1.75 trillion social spending package before Congress. The group commissioned a poll by OnMessage Inc., one of whose partners is Timmy Teepell, the political strategist and former chief of staff when Jindal was Louisiana governor. The poll showed that 58 percent of Granite Staters believe the nation is headed in the wrong direction, while 35 percent believe it is headed in the right direction, Jindal told New Hampshire reporters.

The temperature of the New Hampshire U.S. Senate race significantly dropped Dec. 26 when Gov. Chris Sununu, the most prominent Republican in New Hampshire, announced he would run for second term as governor rather than challenge Hassan, according to the Concord Monitor.

If patients receive a higher bill for these covered services, they should contact the U.S. Department of Health and Human Services at 1-800-985-3059 or the Louisiana Department of Insurance at 1-800-259-5300. For more information, visit https://www.cms.gov/nosurprises/consumers.

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