The new Federal No Surprises Act followed on the heels of some states that had adopted various provisions designed to protect patients in exactly the scenario that you describe. So a radiologist or an anesthesiologist or even an assistant surgeon may provide care during their episode.Īnd if those providers are out-of-network, then a surprise bill may arise where in the absence of patient protections, they can balance bill up to their charges.Īnd those charges can be quite a lot more than what the insurance will pay for.
But while they're having their care, they also see other providers. So if a patient has planned care and they go to an in-network hospital or a potentially in-network ambulatory surgical center, for example, and they might have even chosen in-network surgeon to be their doctor. Can you just give a thumbnail of how a surprise bill can arise in a non-emergency setting? It actually occurs in fairly technical circumstances, particularly when it's not an emergency, which is the focus of your analysis. Your study is on a topic that probably everyone has heard about surprise billing is kind of a catchy term. We'll discuss these findings in today's episode. They found really big differences between New York and California, which has important implications for implementation of this new federal law. And they compare those two states to other states with no surprise billing protections. Comparing trends in provider charges for surprise billing between two states, New York and California, which have different mechanisms for setting surprise bill payment levels. Gordon and coauthors published a paper in the September 2022 issue of Health Affairs. I'm here with Aliza Gordon, Director of research at Elevance, which until recently was known as Anthem.
If the patient isn't liable, how much does the insurance company pay for these out-of-network services? How the rules for setting out-of-network payment rates affect the prices providers charge is the topic of today's episode of A Health Podyssey. Now, the Federal No Surprises Act was signed into law by President Biden in the final days of 2020, and it eliminated the patient's liability for many surprise bills starting January 1st of this year, 2022. The surprise is that the person is responsible for the bill charges, even though their insurance may only pay a small share of those charges. Surprise bills occur when a privately insured patient receives an unexpected bill from someone who's not in their insurance network. Surprise medical bills have been in the news a lot lately. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
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With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Ĭurrently, more than 70 percent of our content is freely available - and we'd like to keep it that way. Order the September 2022 issue of Health Affairs for research on nurses, care delivery, pharmaceuticals, and more. Alan Weil interviews Aliza Gordon from Elevance Health on her and coauthors' recently published paper in the September 2022 issue of Health Affairs comparing trends in provider charges for surprise billing between two states, New York and California, which have different mechanisms for setting surprise bill payment levels.
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