Morning Briefing
Summaries of health policy coverage from major news organizations
Final Rule Issued On How Surprise Bill Disputes Should Be Settled
A year and a half after Congress protected patients from surprise medical bills, the Biden administration has finalized the process for deciding who'll actually pick up the tab. Billions of dollars are at stake — either for providers or for insurers and employers. (Reed and Bettelheim, 8/22)
In a final rule published late Friday, the government said the entities that are meant to settle disputes between insurance companies and out-of-network providers must start their considerations with the median in-network payment rate for the service in question. Many providers don’t want the arbiters to rely on the median in-network payment rates, because they’ll get paid less if those in-network charges are taken into account. Already eight provider groups have sued the government on this point. (Bannow, 8/19)
The regulation, which follows a court decision that struck down part of an earlier policy, instructs arbiters to consider both an insurer's median contracted in-network rate and additional information when determining the correct payment for a surprise bill, including for air ambulance services. The Health and Human Services, Labor and Treasury departments jointly published the final rule. (Tepper and Goldman, 8/19)
