Continuing Assaults on Surprise Out-of-Network Bills

Faegre Drinker Biddle & Reath LLP
Contact

California struck the most recent blow against surprise out-of-network medical bills.  Surprise bills are different from the bills you get when you knowingly choose an out-of-network provider.  Those are painful, but they aren’t a surprise.  The classic example of a surprise bill is the one an out-of-network anesthesiologist sends after surgery by an in-network surgeon at an in-network hospital.

In September California Governor Brown signed Assembly Bill 72 requiring that policies issued on or after next July 1 provide that if an insured patient receives covered services at an in-network facility from an out-of-network provider, the patient needn’t pay more than the in-network provider rate.  There is an exception when the patient has specifically consented to the higher rate; that bill wouldn’t be a surprise.

New York State protects patients from surprise bills not only when they are treated at an in-network facility but also when referred by an in-network physician to an out-of-network physician or service provider, including laboratory services.  The law provides that a patient need pay only the in-network rate, provided he forwards the surprise bill to his insurer, along with an assignment form allowing the out-of-network provider to seek payment from that insurer.

The HHS Budget in Brief for fiscal year 2017 recites yet another approach to the problem: “Hospitals would have to take reasonable steps to match individual patients with providers that are … in-network….  Furthermore, all physicians who regularly provide services in hospitals would be required to accept an appropriate in-network rate….”

Still another approach is reflected in the insurance policy requirements CMS has proposed for 2018: if a patient is required to pay an out-of-network bill for services at an in-network hospital, the excess amount above the in-network rate would count toward the patient’s annual deductible.  2017 Payment Notice at §156.230(e).

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Faegre Drinker Biddle & Reath LLP | Attorney Advertising

Written by:

Faegre Drinker Biddle & Reath LLP
Contact
more
less

Faegre Drinker Biddle & Reath LLP on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide