Evidence on surprise billing: protecting consumers with the No Surprises Act
- Collection:
- Health Policy and Services Research
- Series Title(s):
- ASPE issue brief
- Contributor(s):
- United States. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Office of Health Policy, issuing body.
- Publication:
- Washington, D.C. : Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy November 22, 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Accounts Payable and Receivable Consumer Advocacy -- legislation & jurisprudence Health Care Costs -- legislation & jurisprudence United States United States.
- Genre(s):
- Technical Report
- Abstract:
- On January 1, 2022, the surprise billing provisions of the Consolidated Appropriations Act, 2022--commonly referred to as the No Surprises Act--will go into effect. These requirements address the problem of surprise billing, which occurs when a privately insured individual receives an unexpected balance bill either in an emergency situation or when a service in an in-network facility is provided by an out-of-network provider. Research over the past decade shows that surprise billing is relatively common among privately-insured patients. Studies show that, on average, 18 percent of emergency room visits by people with large employer coverage result in one or more out-of-network bills and nearly 20 percent of patients undergoing in-network elective surgeries or giving birth in a hospital received surprise bills. Surprise bills in these studies averaged more than $1,200 for anesthesia, $2,600 for surgical assistants, and $750 for childbirth. All told, more than half of U.S. consumers report having received an unexpectedly large bill. Key among the No Surprises Act’s provisions is removing the patient from payment disputes between providers and payers in instances where surprise billing occurs and establishing how such disputes will be resolved. The law established the framework for a formal payment dispute resolution process that was set forth in an Interim Final Rule issued on October 7, 2021. State efforts regarding surprise billing dispute resolution indicate that some of the possible approaches may potentially lead to increased health care costs. This experience informed current federal rulemaking.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (10 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918539088506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918539088506676