The No Surprises Act aims to help curb large medical bills, from January 1: Shots

HHS secretary Xavier Becerra says doctors in Congress who like the rules of the “No Surprises Act” do not look like patients. “I do not think when someone overcharges that it will hurt the overcharger now to have to [accept] a reasonable price, “says Becerra. The congressional budget office estimates that the Biden team’s rules will push insurance premiums down by 0.5% to 1%.

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HHS secretary Xavier Becerra says doctors in Congress who like the rules of the “No Surprises Act” do not look like patients. “I do not think when someone overcharges that it will hurt the overcharger now to have to [accept] a reasonable price, “says Becerra. The congressional budget office estimates that the Biden team’s rules will push insurance premiums down by 0.5% to 1%.

BRYAN R. SMITH / FP via Getty Images

Overpriced doctors and other medical providers who can not charge a reasonable rate for their services can be put out of action when new rules against surprising medical bills come into force in January, and that’s a good thing, says Health and Human Services Secretary Xavier Becerra. in defense of the rules.

The proposed rules represent the Biden administration’s plan to execute Law of no surprises, which Congress passed to spare patients the shockingly high bills they receive when one or more of their providers unexpectedly turns out to be outside their insurance plan network.

The law to enter into force on 1 January 2022 – protects patients from these bills, and requires providers and insurance companies to figure out how much doctors or hospitals should be paid, first through negotiation and then, if they can not agree, arbitration.

Medical groups and some medical associations, however, have taken off in the meantime finally rules as HHS revealed last month, saying they favor insurance companies in the arbitration phase. This is because, although the rules tell arbitrators to take many factors into account, they are asked to start with a benchmark largely determined by insurance companies: the median rate negotiated for similar services among network providers.

The bottom line is to protect patients

Medical groups say giving insurance companies a takeover will let them drive down payment rates and potentially force doctors out of networks or even out of business, reducing access to healthcare.

The ward has heard these concerns, Becerra says, but the bottom line is to protect patients. Medical providers who have taken advantage of a complicated system to charge exorbitant rates will have to bear their share of the cost, he says, or close if they can not.

“I do not think when someone overcharges that it will hurt the overcharger now to have to [accept] a fair price, “says Becerra.” Those who leave must either fasten their seatbelts and do better, or they may not keep up the industry. “

“It is not fair to say that we have to let someone erode us in order for them to be up and running,” he adds.

Nevertheless, Becerra says he does not anticipate a wave of closures or reduced access for consumers. Instead, he suggests that a competitive, market-driven process will find a balance, especially when consumers know better what they are paying for.

“We are willing to pay a fair price,” he says, but stresses that “I will pay for the best, but I will not pay for the best and so three times more on top of that and be dazzled by the bill.”

The sticking point: How high bills are negotiated and judged

Becerra also points to a report on surprising medical bills that HHS is set to release on Monday, which was provided to Kaiser Health News in advance, highlighting the effects of bargaining and arbitration laws already in effect in 18 states.

The report, which brings together previous research, found that people were hit by surprise bills averaging $ 1,219 for anaesthesiologists, $ 2,633 for surgical assistants, $ 744 for childbirth and north of $ 24,000 for air ambulances.

In those states that use benchmarks similar to what physicians suggest HHS uses instead of the agency’s current proposals – such as New York and New Jersey – the report found that costs increased. New York, for example, has a “baseball-style” system where the referee chooses between the offers from the provider and the insurance company, even though the referee is told to consider the offer closest to the 80th percentile of fees. “As the amount charged by providers is typically much higher than the actual negotiated rate, this approach risks leading to significantly higher overall costs,” the report notes. In New Jersey, billed fees or “usual and usual” rates are taken into account.

“When the arbitration process is wide open, no boundaries, at the end of the day, health care costs go up, not down,” Becerra says of the methods doctors prefer. “We want costs to fall. And that’s why we want to create a system that helps provide the guide posts to keep us efficient, transparent and cost-effective.”

The system chosen by the Biden administration is expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimates.

“Everyone has to give a little to get to a good place,” Becerra says. “The sweet spot, I hope, is one where patients … are extracted from that food fight. And if there continues to be a food fight, the arbitration process will help determine it in a way that is effective, but it will also lead to lower costs. “

Although the administration chose a benchmark that doctors and hospital groups do not like, the law specifies that other factors must be taken into account when determining the price of a medical procedure or service, such as a provider’s experience, the market and the complexity of a sag. Becerra said these factors help ensure that arbitration is fair.

“What we were simply doing was creating a rule that says, ‘Show the evidence,'” Becerra says. “It must be relevant, material evidence. And let the best person win in that fight in arbitration.”

The preliminary final rules were announced on October 7, giving stakeholders 60 days to comment and seek changes. More than 150 members of Congress, many of them doctors, have asked HHS and other relevant federal agencies to reconsider before the law goes into effect on January 1st. These legislators accuse the administration of not complying with the spirit of the compromises made by Congress in passing the law.

Rules that are so far along tend to come into force with few or no changes, but Becerra says his department still listens. “If we believe there is a need to make changes, we are ready to do so,” the secretary said.

The HHS report also notes that the law requires comprehensive monthly and annual reporting to regulators and Congress when it enters into force, to determine if the rules are out of hand or have undesirable consequences such as those warned by doctors.

Becerra says he believes the rules strike the right balance and favors not insurance companies or doctors, but the people who need medical attention.

“We want it to be transparent so that we can lead to more competition and keep costs down. Not just for the payer, the insurance company; not just for the provider, the hospital or the doctor; but especially for the patients,” he says.

Kaiser Health News is a national, editorially independent newsroom and program for the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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