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July 11, 2022

Despite the No Surprises Act, surprise bills are still common

Daily Briefing

    Although the government's ban on surprise medical bills went into effect on January 1, a new survey from Morning Consult found that one in five adults say they or their family have received an unexpected medical bill in 2022.

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    Background

    Surprise billing occurs when a patient unwittingly receives care from an out-of-network provider and is responsible for all or a large portion of the cost. This can occur when patients are unable to choose an in-network facility or provider because they are receiving emergency care, or their scheduled care team includes an out-of-network ancillary provider.

    In December 2020, Congress passed the No Surprises Act to mitigate patients' exposure to surprise medical bills and require insurers and providers to resolve payment disputes for out-of-network care independently or use a new arbitration process.

    And in 2021, CMS released two interim final rules to implement the law. One restricted out-of-pocket costs for consumers as a result of surprise and balance billing, and the other established a process to settle disputes between out-of-network providers or facilities and health plans over these surprise bills, also requiring providers and facilities to provide uninsured patients a "good faith estimate" of charges expected after an item or service is scheduled or upon the patient's request.

    According to health insurers, the No Surprises Act, which took effect on Jan. 1, 2022, blocked over 2 million potential surprise bills from being passed on to commercially insured patients during the first two months of the year.

    20% of Americans are still receiving surprise bills

    A new survey from Morning Consult found that many Americans are still being charged with unexpected medical costs. According to the survey, the most likely source of unexpected medical bills in 2022 was for in-network lab work that was sent to an out-of-network lab for assessment—a process that is covered under the law. Another common source was testing or procedures that are not covered by insurance, which isn't covered under the law.

    Notably, one in five adults were billed after receiving treatment from an out-of-network doctor at an in-network hospital. Among adults who received unexpected bills, 22% were charged more than $1,000.

    In addition, the survey found that around 1 in 4 adults hesitated to seek medical care or skipped care entirely this year over concerns about getting a surprise bill.

    However, Americans are not equally suspicious of all provider types. For example, just 45% of adults said they were confident they would know their ED bill up front, while 71% expressed confidence that they would know their upfront costs for primary care treatment.

    Meanwhile, 63% of adults, including 61% of those who have received unexpected bills in the past, said they would feel confident addressing a surprise bill they believed to be illegal with a provider or insurer.

    For respondents who said they were less sure about their abilities to resolve a surprise bill, many cited an overall distrust of health care companies and confusion about the surprise billing law itself.

    "I would have no clue where to go to seek advice or help with my bill," one respondent said.

    A spokesperson for Sen. Maggie Hassan (D-N.H.), a cosponsor of the No Surprises Act, said, "As the administration continues to work on implementing the law, it must continue to keep patients out of the middle of billing disputes and raise awareness about this law among both patients and providers." (Galvin, Morning Consult, 7/7; Cass, Becker's Hospital Review, 7/7)

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