New government rules to protect patients from surprise medical bills face pushback from doctors

New rules issued by the US Department of Health and Human Services (HHS) that protect patients from surprise bills face pushback from doctors and scores of members of Congress. Secretary of HHS, Xavier Becerra, says that the goal is to keep physicians and hospitals from charging prices that are significantly higher than the average market price. Most important, patients will no longer have to deal with these unexpected bills.

The rules are the Biden administration’s attempt to make good on Congress’s No Surprises Act. The Act is intended to protect patients with private health insurance from unexpected bills sent to them from out-of-network providers, excluding ambulance companies. Instead of burdening patients with these bills, doctors and hospitals are required to negotiate their rates with insurers. If that doesn’t work, they must go to arbitration.

The HHS rules appropriately assume that a fair rate is around the average that health insurers are paying for similar services. Some doctors groups are suggesting that they might be driven out of business if their rates are forced down to an average rate. But, HHS feels that the primary goal needs to be protecting patients. Moreover, HHS does not believe it will hurt physicians who are charging well over the average rate to accept an average rate.

No patient should be forced to pay two or three times more than the average cost. A recent HHS report on surprise medical bills reveals that out-of-network charges average $1,219 for anesthesiologists and $24,000 for air ambulances.

The HHS rules are projected to bring down health insurance premiums by as much as one percent, according to the Congressional Budget Office.

One hundred and fifty-two Republican and Democratic members of Congress are not happy with the HHS rules and would like to see them revised. They argue that the rules give too much power to the insurers but don’t seem to consider the fact that many physicians and hospitals are using their power to gouge patients and send them into medical debt.

Here’s more from Just Care:

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• Why Congress isn’t stopping ambulances from issuing surprise bills?
• What are Medicare premium and other costs in 2022?
• Costs in Medicare Advantage present barrier to care
• 2021: Programs that lower your health care costs if you have Medicare