The No Surprises Act: a long overdue bill

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Cutting health care costs is the top voter priority for Congress and President Joe bidenJoe BidenBiden to meet with House Dems ahead of trip to Europe: Report 21 House Democrats are calling for removing IRS banking reporting proposal from overnight health care expense bill – Brought to you by Altria – The Vulnerables House Dems push the PLUS drug pricing plan, according to a survey published this summer. Congress has no shortage of solutions to meet these costs. The problem, as with many issues in our polarized times, is to come to an agreement on the details.

This is what made the bipartite agreement 11 months ago on the Law without surprise so unusual. Congress voted to protect patients from surprise medical bills by pulling them out of the midst of payment disputes between off-grid providers and insurers. The law will go into effect on January 1, 2022, not too soon for the millions of Americans overwhelmed by medical bills.

Even before COVID-19 sends us running for testing and treatment, more than two thirds of patients feared receiving a surprise medical bill they could not afford. This is a legitimate concern: there is a one in five chance that we will face a surprise medical bill after receiving treatment in a hospital. hospital Where emergency room. We only find out that these providers and services are not covered by our insurer after the fact – when we are recovering at home and a surprise bill of hundreds or even Thousands of dollars come.

A broad coalition of consumer and patient groups supported the wording of the final compromise in the No Surprises Act because it codifies two important cost-saving measures: it bans balancing invoices from most off-grid providers, and it puts in place an arbitration system with safeguards to help reduce overall costs for all privately insured Americans.

The most recent proposed rule Implementing the law, released on September 30, 2021, is key to ensuring fair and not artificially inflated payment to off-grid providers, as Congress wants. The No Surprises Act has defined an arbitration process that encourages all parties to negotiate based on market conditions in that geographic area and the care provided to the patient. Arbitrators are advised to primarily consider the network average rate, known as the “Eligible Payment Amount (QPA)”, when making their decisions regarding payment allocations. Using QPA as a starting point for paying off-grid providers is a crucial part of the law, as it will not only allow fair prices to be paid to providers, but also reduce costs that could be passed on to consumers under form of higher premiums.

Such incentives are the only way for this law to generate the savings provided for by the Congress Budget Office, who predicted that making off-grid payments more reasonable would reduce premiums by 1%. These savings have been allocated in advance to “pay” for other elements of the 2021 consolidated finance law.

As providers and insurers quibble over these rules, we sent a letter at the Cabinet Secretaries Xavier BecerraXavier BecerraHHS unveils drug overdose prevention plan to improve access to care The No Surprises Act: a long-awaited bill Ohio is suing Biden for overturning the ban on referral to abortion of the Trump era PLUS, Marty walshMarty WalshThe No Surprises Act: A Long Overdue Bill and Janet YellenJanet Louise Yellen Unsecured Fossil Fuel Investments Risk Global Financial Crisis: Biden Letter, Democrats Lies About Wealth Tax, And Much More Elon Musk Tears Democratic Billionaires’ Tax Plan MORE (last week) congratulating them for staying true to the law’s consumer-centric goals.

Millions of insured Americans anxiously await the entry into force of the No Surprises Act, with the rules that clarify its arbitration clauses. The bill was one of the few things both houses of Congress and both parties agreed to last year. It is high time to end the unfair practice of surprise billing which is costing patients hundreds to thousands of dollars and driving our premiums up. Finalizing strong arbitration rules before January 1 can help achieve this.

Patricia Kelmar, JD, is Director of Campaigns for US PIRG Health Care.


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