HHS unveils rule to crack down on surprise medical bills

The U.S. Department of Health & Human Services has announced an interim final rule to restrict excessive out-of-pocket costs from surprise billing and balance billing.

Surprise bills arise when someone unknowingly gets medical care from a provider outside their health plan’s network, the federal agency notes. Balance billing, meanwhile, occurs when a provider charges a patient for the remainder of what their insurance doesn’t pay for. That practice is prohibited in Medicare and Medicaid, and the new rule would extend similar protections to people insured through employer-sponsored and commercial health plans, HHS says.

The interim rule would ban surprise billing for emergency services, which would be treated on an in-network basis without any prior authorization needed. The rule would also ban high out-of-network patient cost sharing (through deductibles and co-insurance) for both emergency and non-emergency services by requiring that cost sharing not exceed the amount charged by an in-network provider, according to HHS. The rule would also ban out-of-network charges for ancillary care, such as an anesthesiologist, that’s provided at an in-network facility.

Other out-of-network charges would be banned without advance notice by requiring healthcare providers to give patients a “plain-language” consumer notice explaining that patient consent is required for non-network medical services, HHS says.

The interim final rule, which was issued with request for comments, is the first of several provisions enacted through the “No Surprises Act” passed in 2021. The interim regulations will go into effect on Jan. 1, 2022 for healthcare providers and facilities. For group health plans, health insurance issuers and Federal Employees Health Benefits Program carriers, the new rule provisions will take effect for plan, policy or contract years beginning on or after Jan. 1, 2022.