May 25, 2022 - Health

Ban has prevented 2 million surprise medical bills so far, insurers say

Illustration of a pharmacy script presented as a bill with change on it.

Illustration: Sarah Grillo/Axios

The federal surprise billing ban prevented 2 million potential unexpected medical bills from reaching privately insured patients early this year, according to an analysis released by leading health plans Tuesday.

Why it matters: Insurers, providers and employers are waiting for the Biden administration to lay out a new arbitration process for settling payment disputes after a federal judge tossed out a proposed fix in late February.

Background: The surprise billing law bans many types of out-of-network medical bills and puts the onus on doctors and health plans to settle disputes or request arbitration while holding patients harmless.

A key factor: The arbiter was supposed to select the offer closest to the median in-network rate unless other information showed the rate wasn't appropriate.

  • Hospitals and the American Medical Association successfully challenged that process, saying the median in-network rate shouldn't be the guiding factor.

What they're saying: America's Health Insurance Plans and the Blue Cross-Blue Shield Association said their analysis shows the process established a measure of predictability in health costs.

  • If even a fraction were settled through dispute resolution, it would far exceed the government's estimate, the insurers said.
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