Even though the provisions go into effect on Sept. 23, payors do not have to implement them until the beginning of their new coverage year. Furthermore, the provisions apply only to new health plans, with existing payors exempted from some regulations, and out-of-network providers can balance-bill patients for amounts the payor doesn’t cover.
As written, the provisions would “create a disincentive for insurers to engage in good faith negotiations with providers,” the AHA stated in a letter to HHS’ new Office of Consumer Information and Insurance Oversight. This would result in “unreasonable payments for emergency services rendered by out-of-network providers and large balance bills for consumers.”
Read the AHA News Now report on ED services.
Read the AHA letter.
Read more coverage on emergency departments.
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