Doctors Are Upset About New Medical Bill Rules

 

Doctors are mad about surprise billing rules. Becerra says stop gouging patients


Overpriced doctors and other medical providers who can't charge a reasonable rate for their services could be put out of business when new rules against surprise medical bills take effect in January, Health and Human Services Secretary Xavier Becerra says in defending the regulations.

The proposed rules represent the Biden administration's plan to carry out the No Surprises Act, which Congress passed to spare patients from the high bills they get when one or more of their providers unexpectedly turn out to be outside their insurance plan's network.

The law shields patients from those bills, requiring providers and insurers to work out how much the physicians or hospitals should be paid, first through negotiation and then, if they can't agree, arbitration.

Doctor groups and some medical associations, however, have lashed out at the interim final rules that HHS unveiled last month, saying they favor insurance companies in the arbitration phase. That's because although the rules tell arbiters to take many factors into account, they are instructed to start with a benchmark largely determined by insurers: the median rate negotiated for similar services among in-network providers.

The doctor groups say giving the insurers the upper hand will let them drive payment rates down and potentially force doctors out of networks or even out of business.

The department has heard those concerns, but the bottom line is protecting 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't.

The report found people getting hit with surprise bills averaging $1,219 for anesthesiologists, $2,633 for surgical assistants, $744 for childbirth and north of $24,000 for air ambulances.

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

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