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The Impact of Surprise Medical Billing

Starting on the first day of 2022, US patients will finally receive protections from surprise medical bills—unexpected and often expensive bills that come from receiving out-of-network care—as new legislation will allow healthcare providers to challenge insurers for inadequate payments for out-of-network care instead of burdening patients with the costs.  

It’s an important change for the US medical billing landscape, one Health and Human Services (HHS) Secretary Xavier Becerra calls “the most critical consumer protection law since the Affordable Care Act.” 

That’s a big statement, but it might just ring true. Here’s what you need to know: 

What is Surprise Medical Billing? 

Surprise medical billing occurs when a patient receives a medical bill larger than what they expected, due to their care provider being out-of-network. This is considered a surprise because the patient is usually not aware that they received out-of-network care.  

The most common example of surprise medical billing takes place when a provider who is out-of-network is rendering services at an in-network hospital. This occurs most often in emergency situations when a patient is not able to clarify the cost of care before services are rendered.  

Surprise medical billing often leaves patients with large unexpected medical expenses, sometimes totaling hundreds of thousands of dollars. 

How Often Does It Happen? 

Research shows that nearly one in five patients who go to the emergency room, have elective surgery, or give birth in a hospital receive surprise bills. Furthermore, as many two-thirds of ambulance rides are out-of-network.  

Surprise bills happen most commonly in emergency care situations, due to the fact that patients rarely choose where they are to receive emergency care. 

How Do Surprise Medical Bills Impact Patients? 

The impact on the patient is largely the unexpected medical cost that falls in their lap after unplanned emergency care. When a patient enters an emergency room, they aren’t stopping to ask if the doctor is part of their insurance network—especially since it’s common for in-network hospitals to employ out-of-network providers. 

Surprise medical billing often leads to financial hardship for patients who are not prepared to pay such a large sum. 

How Do Surprise Medical Bills Impact the Provider? 

Providers who operate out-of-network tend to do so because the insurance or health plan compensation for their services is too low. They also want to make decisions that are best for the patient rather than worry about coverage and payment, and they don’t want to operate under the restrictive nature of healthcare plans.  

Surprise medical billing impacts the provider only if they operate out-of-network. The provider must pass the bill to the patient, and what happens from there depends on whether or not the individual can pay the unexpected bill. 

What’s Being Done? 

The No Surprises Act offers valuable protection for patients and providers alike. For patients, the new law prevents most surprise bills for insured patients and guarantees uninsured patients the right to a good-faith price estimate before services are rendered. 

For providers, the No Surprises Act helps ensure fair compensation for services rendered. It does this by eliminating some problematic billing provisions, giving physicians more time to pursue independent dispute resolution for unpaid bills, and by introducing third-party arbiters to help resolve claims. 

Are You Ready? 

This new protection against surprise billing will fundamentally change the way medical bills are handled. Make sure you’re ready with the latest solutions for managing your practice and streamlining your workflow. 

CollaborateMD can help you to operate more efficiently, generate more revenue, and take advantage of the new surprise billing protections afforded by the No Surprises Act. If you want to see how it can benefit you, schedule your free demo today! 

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