Surprise Billing

The recently passed COVID-19 relief bill contains measures to curb “surprise billing” on a federal level. Surprise bills typically stem from a patient being treated by an out-of-network physician at an in-network facility, leaving the patient liable for the physicians charge above and beyond any negotiated rate by insurance. More than half of states have surprise billing protections in place; however, self-insured health plans are not subject to those laws.

The new federal protections will be effective 1/1/2022, allowing these billing disputes to go through an independent process, unless the patient is provided 72 hours’ notice and a good faith estimate of the charges. Also included in the legislation is a ban on surprise billing from air ambulance providers. The legislation is a win for consumers; however, self-insured employers must be cognizant of the potential shift in cost from the member to the group health plan.

If you would like more information, please contact a Crown Risk Management representative.