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Illustration: Maura Losch/Axios

Effective today, federal law bans many types of out-of-network medical bills and puts the onus on doctors and health insurance companies to resolve their payment disputes.

Why it matters: Consumers can breathe a sigh of relief because, in many scenarios, they should no longer face unexpected charges from doctors who are not in their insurance networks.

How it works: Patients still have to pay in-network copays, deductibles and other cost-sharing, which have been rising, but any additional out-of-network bills are now prohibited for the following services:

Of note: Ground ambulances are not included in this law, meaning three out of four insured people who take an ambulance ride are still at risk of facing surprise bills.

Behind the scenes: Instead of sending out bills, doctors and insurance companies have to resolve their differences while holding the patient harmless.

  • If the two sides can't agree on a payment rate within 30 days, either side can request the federal arbitration process.
  • The doctor and insurer then go to the arbiter with their best offer, and the arbiter picks one.

An important point: The arbiter "must select the offer closest" to the median in-network rate unless other information "clearly demonstrates" the median in-network rate isn't appropriate, according to the government.

  • A host of medical providers, including the American Hospital Association and American Medical Association, are suing the government. They argue the median in-network rate shouldn't be the guiding factor for the arbiter, and the government went against Congress' intent by doing so.
  • Consumer protection experts have criticized the lawsuits, saying medical providers don't want guardrails on the arbitration system so they can extract higher rates.

Between the lines: Because this is a new law, we should expect the health care system won't get everything right.

  • "We need to be active bill readers and ask a lot of questions to our providers and insurance companies if there's a bill we don't think we should be paying," said Patricia Kelmar, the health care director at consumer protection group U.S. PIRG.
  • Patients can direct complaints online or through a 1-800 number.
  • Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)

The bottom line: The law will save a lot of patients from financial ruin. But a lot of gaps remain in the health care system.

Have you been hit with a large or unexpected medical bill? Maybe the overall medical billing experience left you feeling puzzled or upset? Email bob@axios.com, so we can dig into what's happening as part of Axios' new series, Billed and Confused.

Go deeper

D.C. nurses call on feds to tackle staffing shortages

Illustration: Shoshana Gordon/Axios

A group of about thirty unionized nurses and labor rights activists gathered yesterday outside the Howard University Hospital, toting signs calling for action to address nationwide staffing shortages — which they say pre-date the pandemic and have since only gotten worse.

Why it matters: Health care workers across the country are burnt out as the pandemic wears on, exacerbating staffing shortages as those workers, including nurses, quit due to overwork and stress.

Thousands without power as "hazardous" winter storm lashes East Coast

Satellite imagery of the Northeastern U.S. taken by NOAA on Jan. 17. Photo: NOAA

A major winter storm was lashing much of the East Coast on Sunday, causing widespread power outages and disrupting travel over the holiday weekend.

The latest: The Weather Prediction Center said in a storm summary Monday that winter storm warnings are still in effect for portions of the Central Appalachians, Ohio Valley, interior Mid-Atlantic, and Northeast, while portions of the Central Appalachians and coastal New England are under high wind warnings.

Colleyville Rabbi credits survival to active-shooter training

Rabbi Charlie Cytron-Walker, one of the people taken hostage in a synagogue outside Fort Worth on Saturday, said in an interview with CBS Monday that he initially took in the man because he thought he needed shelter.

The big picture: Cytron-Walker said he spoke to the hostage taker, identified by the FBI as 44-year-old British national Malik Faisal Akram, for several minutes and made him tea before Akram took the rabbi and three other people hostage during Shabbat services for around 11 hours in Colleyville, Texas.

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