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Surprise Billing and Covid


Surprise billing occurs when a patient receives a large bill they never anticipated from an out-of-network physician, ambulance or health care entity.The Kaiser Family Foundation found 19% of people received a surprise bill within the last 2 years. For air ambulance transfers, 69% of people received a surprise bill. As many as 1/5 emergency room visits can result in a surprise bill and some patients face up to a $100,000 surprise that is not covered by their insurance because it was "an out-of-network" provider. The most common surprise bill comes from ground ambulances, a service people don't choose. (Old people are protected as Medicare does not allow ambulances to bill for more than the rate Medicare pays).


Some private equity firms have turned surprise billing into a lucrative business model as they buy up emergency doctors and specialists and move them out of network so they can charge higher fees. Private equity companies have poured tens of millions into keeping the status quo, despite the effect on consumers. Even though 80% of people want this practice banned, congress and legislators have been unable and unwilling to stop the practice. Dark money in the health care industry likes it just the way it is.


One good outcome of the Covid-19 pandemic is that it pushed bi-partisan congress into action as patients received huge bills for Covid care. New legislation called "The No Surprises Act", passed in December, will be effective in 2022. (darn! this is only 2021). It will protect patients from surprise bills for emergency services provided by out-of-network providers or emergency rooms and air ambulance services. It also covers non-emergency services for which patients do not consent. The cost will be limited to in-network cost sharing amounts.


It's not perfect.There is a provision for independent dispute arbitration and the specifics of this are not well defined and can be altered by the States. There is no bench-marking for cost and high prices can continue with private-equity owned physician staffing firms. Ground ambulances were left out of the act and can still bill patients whatever they want. (In Moraga/Orinda, California it is $2600 plus $42/mile. In Marion County, Fla it is $550 plus $11.25/mile.). But considering the long standing lack of movement to protect consumers from surprise billing, we should be glad there are now some protections for the little guy.

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