(Washington, DC, Friday, December 17, 2021) For years, surprise billing has proliferated as a lucrative business model for private equity-backed providers and other out-of-network entities seeking to extract maximum profit by price-gouging patients, families, employers, and employees across the country.
- Researchers have consistently found that out-of-network providers routinely demand higher charges that far exceed Medicare or in-network costs for similar services, and in turn, allow these specialists to negotiate artificially high in-network rates.
- Four specialties that are often out-of-network — anesthesiologists, pathologists, radiologists and assistant surgeons — raised spending in employer-provided coverage alone by 3.4%, according to a 2019 Health Affairs study.
Starting January 1, 2022, the No Surprises Act will safeguard millions of Americans from surprise medical bills in instances where they had no control or choice over their care. The historic patient protections included as part of the law will fix long-standing loopholes in our health system, specifically by: Extending comprehensive federal consumer protections to 177 million Americans covered by employer-based plans, as well as millions more in states without surprise billing protections
- Banning surprise bills for emergency services, such as air ambulance rides or care provided by out-of-network providers;
- Banning surprise bills for nonemergency services delivered by out-of-network providers like anesthesiologists, pathologists, and radiologists, working at in-network hospitals; and
- Prohibiting out-of-network providers from sending patients bills for “excess charges” beyond in-network cost-sharing.
Importantly, the No Surprises Act reverses an unsustainable, harmful trend of soaring medical expenses that ultimately leads to higher premiums and out-of-pocket costs for patients. The Congressional Budget Offices estimated the No Surprises Act will reduce private health plan premiums by 0.5-1% on average and reduce the federal deficit by $17 billion over 10 years.
The law’s patient protections and cost-savings measures are inherently tied to limits on out-of-network providers’ abuse and exploitation of the system, particularly related to the federal arbitration, or the independent dispute resolution (IDR) process. Any change to the IDR rules before January 1, 2022 would likely also lead to a delay in the patient protections taking effect at the start of the year.
Members of the Coalition Against Surprise Medical Billing, which represent leading employer groups, health insurance providers, health organizations and the tens of millions of people they employ and serve each day, support meaningful solutions to end surprise medical billing.