The healthcare industry is ramping up a lobbying campaign in hopes of swaying the federal agencies working to enforce a law passed last year that bans hospitals and doctors from sending out unexpected bills to patients for care not covered by their insurance companies.
Large hospital systems and health insurers, air ambulance companies, and more are lobbying the Biden administration, which is now tasked to make the new law work, and patient advocates are concerned if the protections could be weakened while the rules are set up on the law, and leaving consumers to still face large bills they didn't expect to get.
The unexpected bill practice faced bipartisan condemnation, but health groups fighting the law said there is concern over who will be responsible for picking up costs for medical care that they can no longer bill to patients.
The legislation was passed as part of the year-end spending bill, but the industry is already gearing up for battle against Democrat healthcare reforms that include work on drug prices and lowing the age for Medicare recipients.
One consumer advocate, speaking on the condition of anonymity because they are in contact with the administration, said the Department of Health and Human Services "is going to have to be really hard-hitting, or it’s another squishy law that’s supposed to be preventive but is totally circumventable."
The law's first major deadline will happen in July, and federal officials must solve complications such as working on ways to make sure patients aren't signing away new protections, determine how to monitor and punish providers violating the ban, and work out a process to settle disputes. The ban is due to take effect next January.
Surprise bills often happen during emergency room visits, when a patient can be sent to a hospital outside their coverage network or even get care in a hospital that is covered by a specialist that is not in their network.
Planned procedures like surgeries often come with a surprise, when a patient can be treated by an out-of-network specialist like an anesthesiologist.
According to a JAMA study, an estimated one out of five patients gets a surprise bill after elective surgery. A study from the USC Schaeffer Center for Health Policy and Economics last fall showed that the practice can also drive up health insurance premiums, but cutting surprise bills could save more than $12 billion and $38 billion in premium costs.
The last Congress worked on the bill for two years after physician staffing groups that were backed in some cases by private equity interest attacked the bill's bipartisan framework.
Hospitals also fought agains the plan, saying it favors insurers and could set price controls, and as a result, the final legislation came out as more friendly to providers than patients.
Now, patients are expected to pay their insurers' network rate when they get care from an outside provider, and doctors and insurers are to negotiate over remaining charges.
However, the Biden administration must hammer out the details, including how insurers should calculate initial payments, which could affect what patients must pay from their own pockets.
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