Last Revision: Dec. 30, 2020
American healthcare consumers have won two recent and hard fought victories for hospital pricing transparency and an end to surprise medical bills from a practice called “balanced-billing” that enabled out-of-network providers to send bills to people for the amount that insurance did not cover.
Hospital Pricing Transparency
Once again the healthcare power players, this time the American Hospital Association (AHA), tried to block consumers from accessing transparent information about their prices. Fortunately, U.S. District Judge Carl Nichols in Washington, D.C. dismissed the AHA’s challenge to a Centers for Medicare & Medicaid Services Price Transparency Final Rule requiring them to disclose the prices they negotiate with insurers. The rule will take effect beginning on Jan. 1, 2021. Count on the AHA to appeal to continue their efforts to block informed decision-making by consumers. You can follow the case “American Hospital Association et al v Azar, U.S. District Court, District of Columbia, No. 19-03619.
New “Balanced Billing” Protections
While consumers will still have to deal with high prices for prescription drugs and certain health care services, at least they will now be protected against unexpected bills from out-of-network providers of emergency care, air ambulance transportation, and nonemergency care at in in-network hospital when unknowingly treated by an out-of-network provider, including anesthesiologist and laboratories. This bill does not cover ground ambulance services.
The bill does include provisions for consumers who want to use an out-of-network provider and are willing to forfeit protections to see the provider of their choice.
Consumers need to be aware that this new law does not go in effect until 2022.