Our Turn: No more surprise billing

Published: 12/30/2021 6:00:36 AM
Modified: 12/30/2021 6:00:08 AM

According to the American Journal of Public Health, nearly 67% of personal bankruptcies in the United States are tied to medical expenses. Fortunately, the days of surprise medical bills are largely coming to an end thanks to state action and a new federal law.

Imagine that you are working on a home improvement project when you fall off a ladder, hitting your head and breaking your arm. Fortunately, your injuries are not life-threatening but you require immediate care at the nearest emergency room.

Upon arrival, your treatment includes imaging and radiology services, as well as minor surgery to repair your broken arm. While this has been a traumatic experience, thankfully you have a health insurance plan that will cover the expenses of this ordeal, right? Well, maybe not.

What if the doctor who performed the surgery was in your health plan’s network but the anesthesiologist or the assistant surgeon who helped the doctor are out of network? Situations like this could make you one of the thousands of Americans who will be stuck with a balance or “surprise” medical bill.

What is surprise billing? Normally, most commercial health plans require or prefer consumers to use in-network providers, which are health care professionals and facilities that contract with health insurance plans to provide lower-priced services in exchange for being part of the health plans’ network. Surprise billing happens when the health provider bills the patient for additional amounts after the insurance company pays its portion of the bill.

Out-of-network physicians, not bound by contractual, in-network rate agreements, have the ability to bill patients for the entire remaining balance, up to their full charge amount. These out-of-network providers often include surgical assistants, anesthesiologists, pathologists and radiologists. It can happen for both emergency and non-emergency care.

Part of what makes surprise billing so pernicious is that patients often have no idea that the facility or provider is out of network until they receive the bill. In many cases, services are blended between providers who are in and out of network or they occur in an emergency situation where care is required at the closest health care facility. In worst case scenarios, you might be incapable of choosing an in-network emergency care provider without risking health or life.

Fortunately for granite staters, New Hampshire has been at the forefront of protecting consumers against surprise bills. In 2018, at the urging of Gov. Chris Sununu and the New Hampshire Insurance Department, the state legislature passed legislation prohibiting out-of-network anesthesiologists, pathologists, radiologists and emergency physicians from “surprise billing” a commercially insured patient when the care was provided at an in-network hospital.

Now, the newly passed federal No Surprises Act (NSA) will extend those protections and end the practice of surprise billing in most aspects of commercial insurance beginning on January 1, 2022. Between state law and the federal NSA, consumers with either a fully or self-insured health plan will have protection.

Passed with bipartisan support in Congress and signed by President Trump, the NSA makes it illegal for health providers to bill patients at higher rates than in-network cost-sharing (copays and deductibles) in their current health plan. If a dispute arises over a balance billing issue, the NSA removes the patient from the argument and provides a dispute resolution process for the healthcare provider and the insurance company to find the appropriate cost which the insurance plan will then cover.

The federal government anticipates that states will be the predominant enforcement entity of the NSA and the New Hampshire Insurance Department is ready to undertake that responsibility. As always, we are working hard to provide information to Granite Staters that details the protections they are now afforded under state law and the NSA.

More informational documents can be found at nh.gov/insurance that explain the details of the law and its impact on insurance companies, healthcare providers and patients. 

(Christopher Nicolopoulos of Bow is the commissioner of the New Hampshire Department of Insurance. D.J. Bettencourt of Salem is the Deputy Commissioner of the New Hampshire Department of Insurance.)

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