Thread by @larry_levitt

Here's a link to the COVID relief bill.

The provisions protecting patients from surprise medical bills starts on page 4,095.

rules.house.gov/sites/democrat…

Congress is finally poised to protect patients from surprise medical bills.

It took a pandemic to overcome a political fight over how much insurers should pay out-of-network doctors and hospitals.

Insurers, employers, and consumers have argued payments to out-of-network providers should be based on a benchmark like in-network negotiated rates.

Providers favored an arbitration process for determining payment.

The bill Congress is poised to pass calls for arbitration.

There are guardrails on the surprise bill arbitration process.

Arbitrators must consider the prevailing in-network negotiated payment rates.

Arbitrators must not consider Medicare and Medicaid rates (which are lower) or provider charges (which are higher).

The pandemic tilted the political leverage towards doctors and hospitals and away from insurers in establishing an arbitration process rather than a benchmark payment.

Importantly, patients will be protected from surprise medical bills no matter what.

You know who won't be protected from surprise medical bills in the legislation Congress is about to pass? People in short-term insurance plans that have been expanded by the Trump administration.

18% of ER visits and 16% of in-network inpatient hospital admissions include an out-of-network charge and potential surprise bill for patients.

healthsystemtracker.org/brief/an-exami…

Many states have passed laws protecting patients from surprise medical bills. But, states cannot regulate self-insured employer plans, which 62% of people with employer-provided insurance. The new federal legislation about to pass will extend protections to them.

These are the kinds of surprise bills that will be prohibited:

You go to an ER and the hospital or doctors bill you over and above what your insurance pays.

You go to an in-network hospital and an out-of-network doctor treating you bills you extra.

The new federal legislation will end surprise medical bills, but won't end every nasty surprise patients can get when using the health care system.

There are still deductibles, complicated drug formularies, claim denials, and all sorts of other complications patients encounter.

Patients are the big winner here, gaining protection from surprise medical bills. They've effectively been held hostage as well-funded health care industry groups battled over how much out-of-network providers would get paid.

The surprise medical billing ban doesn't take effect until January 1, 2022, so patients should still be wary until then.

There's some confusion around how arbitration of surprise bills would work.

Patients do not have to go through arbitration. They are shielded from surprise bills. Period.

Arbitration is between insurers and providers to determine how much gets paid.