What once appeared to be an easy fix to the problem turned into a two-year slog in the last Congress, after physician staffing groups — in some cases, backed by private equity interests — spent heavily attacking the initial bipartisan framework for ending surprise bills. Hospitals also fought the plan, which they argued favored insurers and hinted at price controls. To get a ban passed before the last Congress adjourned, lawmakers punted on settling many of the thorniest issues.
But the Biden administration is left with the task of filling in many of the details, including how insurers should calculate the initial payment to out-of-network providers before both sides agree on a final cost. That will ultimately affect what patients must pay from their own pockets. Determining that rate, which will be pegged to local in-network costs, will be made harder by the fact that privately negotiated rates for health care services are often hidden.
“The concept of consent brings the consumer back in, and that’s troubling,” said Patricia Kelmar, director of health care campaigns for the consumer advocacy group U.S. PIRG. “Consent is a jab in the wall that protects the consumer.” "Congress in the legislative text set out that all the arbitration factors should be all weighed equally,” said spokesperson Laura Wooster. “On the regulatory side, we want to make sure that’s preserved. If it’s not explicitly laid out in the regulation, it’s easier down the road over time to become a little lopsided [for insurers]."
'In our day it appears as the struggle of freemen to gain and hold the right of self-government as against the special interests, who twist the methods of free government into machinery for defeating the popular will.' -TR
The US health care industry is an abomination and a national disgrace. It cannot even provide its own frontline workers with proper PPE and living quarters but it can provide back office execs with early vaccines. SinglePayer is half a century overdue. Pass it now.
Everyone I know has been hit with a surprise out-of-network bill, including me; despite calling ahead for the exact cost of the procedure. You can’t get a straight answer & NOBODY wants this practice, except insurance co’s. I hope HHSGOV works to withstand lobbyist pressure.
If only there were a permanent one time solution to this crisis... Some kind of bill that made healthcare free of charge. Oh wait, Medicare For All!