A ban on “surprise” medical bills is expected to take effect January 1, 2022, according to Biden administration officials.
The rules will protect patients from receiving a huge bill following a medical crisis if the closest emergency department was outside their insurance plan’s provider network, or for care from an out-of-network clinician performed at an in-network hospital. Going forward, in these scenarios, patients will only be liable to pay their in-network cost sharing amount.
When the ban takes effect, insurers and service providers who disagree over fair payment can initiate a 30-day negotiation process. If they are unable to reach an agreement at the end of the 30 days, they can involve an independent arbitrator who will use a set amount as a guideline to balance the value of medical services provided with the goal of keeping costs under control. Biden administration officials said 50 organizations have already expressed interest in taking on the role of arbitrators.
Additionally, uninsured individuals and patients paying out of pocket will have access to an estimate of charges for medical procedures and a process for resolving billing disputes. Prior to the ban, patients have had to take it upon themselves to settle unexpected charges or risk being placed into collection proceedings, while hospitals or doctors go back and forth with insurance companies until they reach an agreement, of which there is no guarantee.