Surprise billing in the US: 4 things to know

Surprise billing rules will take effect Jan. 1 and are intended to protect patients from unexpected costs and create a process for payers and providers to settle disputes.

Four things to know about surprise billing, according to a Nov. 22 report by the Assistant Secretary for Planning and Evaluation:

1. The requirements target surprise billing problems, which is when privately insured patients receive an unexpected medical cost during an emergency or when an out-of-network provider provides care at an in-network facility.

2. According to studies, 18 percent of emergency room visits by people with large employer coverage lead to one or more out-of-network bills. About 20 percent of patients who go through in-network nonemergency surgeries or labor get surprise bills. The costs of these bills are on average $1,200 for anesthesia, $2,600 for surgical assistants and $750 for childbirth. More than 50 percent of Americans have received an unexpected and expensive bill.

3. The interim final rule announced Oct. 7 will leave patients out of payment disputes and instead creates a process for providers and insurers to figure out a deal between themselves.

4. State efforts on surprise billing dispute resolution have led to higher healthcare costs in some cases because they can give providers more leverage to negotiate in-network rates. This informed federal rulemaking, according to the Assistant Secretary for Planning and Evaluation.

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