Americans to Get Relief From Surprise Medical Bills as Ban on Charges Takes Effect in 2022

Americans are set to see some relief from "surprise" medical bills after a new ban from the Biden administration takes effect in 2022, the Associated Press reported. The new consumer protections will prevent patients from getting hit with huge bills from an out-of-network provider after suffering a medical crisis that forced them to go to the nearest emergency room.

"We're hoping to give folks a sigh of relief, who have been blindsided by billing," said Health and Human Services Secretary Xavier Becerra.

Once the ban goes into effect on January 1, patients will also be barred from seeing hefty charges if an out-of-network doctor or surgeon aids in a procedure while being treated at a hospital inside their network, according to the AP.

Meanwhile, the new system will have hospitals, doctors and insurers engage in a 30-day negotiation process to solve disagreements on payments and fees, while an independent arbitrator will step in to help if they can't reach an agreement.

For more reporting from the Associated Press, see below.

There's also a new way for uninsured people and certain patients who pay their own way to get an estimate of charges following an emergency procedure.

Surprise medical bills have been a common problem for people with health insurance, all the more irritating because most patients might have thought they were protected. Charges running from hundreds to tens of thousands of dollars came from doctors and hospitals outside the network of patients' health insurance plans. It's estimated that about 1 in 5 emergency visits and 1 in 6 inpatient admissions triggered a surprise bill.

Although many states already have curbs on surprise billing, federal action was needed to protect patients covered by large employer plans, which are regulated at the national level. A 2020 law signed by then-President Donald Trump laid out a bipartisan strategy for resolving the issue, and the Biden administration filled in critical details.

The idea was to take patients and their families out of the financial equation by limiting what they can be billed for out-of-network services to a fee that's based on in-network charges. That amount gets counted toward their in-network annual deductible.

The new protections are aimed at:

— Protecting patients from surprise bills arising from emergency medical care. Protections apply if the patient is seen at an out-of-network facility, or if they are treated by an out-of-network clinician at an in-network hospital. In either case, the patient can only be billed based on their plan's in-network rate.

— Protecting patients admitted to an in-network hospital for a planned procedure when an out-of-network clinician gets involved and submits a bill.

— Requiring out-of-network service providers to give patients 72-hour notice of their estimated charges. Patients would have to agree to receive out-of-network care for the hospital or doctor to then bill them.

Before the ban on surprise billing, patients usually had to take the initiative themselves to work out unexpected charges. In many cases, the hospital or doctor would go back and forth with the insurance company until they reached an agreement. But there was no guarantee that would happen, and patients were at risk of being placed into collection proceedings in situations they had no control over.