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Federal Rule Will Ban Surprise Out-of-Network Healthcare Charges

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Federal Rule Will Ban Surprise Out-of-Network Healthcare Charges

The Biden administration has issued a rule that will prevent in-network providers under most private insurance plans from billing for out-of-network charges at their facilities, according to a news release from the U.S. Department of Health and Human Services (HHS).

Currently, it is perfectly legal for in-network healthcare providers under private insurance plans — hospitals and other facilities that agree to be part of a health insurance plan’s provider network — to exclude certain doctors or other healthcare professionals from insurance plans. This means that if you receive care at an in-network facility but are treated by a doctor who isn’t a member of the provider network, you could be billed for that doctor’s services at out-of-network prices — which can be astronomical compared with in-network prices, depending on the specific insurance plan. Worst of all, it can be nearly impossible to avoid these charges, since in a hospital setting, you often can’t choose which doctor treats you or even easily find out if a doctor isn’t part of your provider network.

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New rule bans out-of-network charges for emergency services

The new rule, which still has to be finalized, takes a number of steps to ensure that people aren’t stuck with surprise medical bills. Starting in 2022, it will ban out-of-network charges for emergency services under all affected insurance plans — even if they take place at a hospital or other facility that isn’t part of your insurance network. There can also be no requirements for prior authorization for emergency services at out-of-network facilities. Insurance providers also won’t be allowed to require higher cost-sharing (a deductible or copayment) for either emergency or non-emergency services provided by out-of-network doctors at in-network facilities.

Addressing one of the most common situations in which people receive surprise bills for out-of-network services, the rule will ban out-of-network charges for “ancillary care” — like an anesthesiologist or assistant surgeon — at all in-network facilities in all circumstances. For other kinds of out-of-network care offered at in-network facilities, those facilities will be required to give patients a notice explaining, in plain language, that they will be billed at an out-of-network rate of they choose to receive a service or see a healthcare professional.

“These provisions will provide patients with financial peace of mind while seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses,” the HHS news release states. “Tackling surprise billing is critically important, as it often has devastating financial consequences for individuals and their families.” Right now, according to the news release, about one in six emergency room visits and inpatients hospital stays involves at least one out-of-network provider, resulting in surprise charges.

“No patient should forgo care for fear of surprise billing,” said HHS Secretary Xavier Becerra in the news release. “With this rule, Americans will get the assurance of no surprises.”

Want to learn more about saving on your diabetes care? Read “How Your Healthcare Team Can Help You Save on Medications,” “Save Money on Medicines,” and “Do’s and Don’t’s for Saving Money With Diabetes” 

Living with type 2 diabetes? Check out our free type 2 e-course!

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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