Good news in ’22: Patients mostly see end to ‘surprise’ medical bills

joy-300x268Here’s a bit of good news that may make patients jump for joy to start off 2022: Surprise medical bills mostly are supposed to end, effective Jan. 1.

Consumers still must watch out for potential big hits on their emergency transportation costs and they will need to ensure scheduled services with medical providers occur “in network.”

Just a reminder that Congress surprised its critics at the close of 2020 by passing in bipartisan fashion a ban of a practice that patients complained was one of the worst financial menaces in their medical care: surprise bills.

These resulted from insurers and companies trying to save money by forcing patients into “narrow networks” of providers, with whom payers negotiated most favorable prices for services and goods. Patients weren’t happy with this move, as insurers suddenly and often kept favored providers (individuals and institutions) with big reputations — and sometimes higher costs — away from them and out of their networks.

Doctors and other providers were more upset with what they viewed as an intrusion on their capacity to maximize their earnings — and they came up with workarounds that put patients in the middle of the fight as financial hostages.

Patients complained loudly to politicians and lawmakers that they were getting ambushed with sky-high provider charges, notably expenses for emergency treatment, as well as from specialists whose contributions to their care they had little to say about, including anesthesiologists, pathologists, radiologists, and “consultants” who might pop into a procedure while patients were knocked out or incapacitated.

Media organizations and excellent reporters nailed providers with articles on outrageous, unexpected medical charges.

The politically riven Congress actually responded to constituents’ howling. Lawmakers left it to federal regulators, though, to develop the system that would be reasonable for the battling insurers and providers — and that mostly got patients out of fee fights to which they never should have been exposed. (It also is worth noting that the courts in the new year will take up a legal challenge to the way the federal government has decided payers and providers will determine compensation for out-of-network care, aka what once were costs shoved on patients as “surprise” bills.)

Lawmakers and regulators, for the most part, have not tried to deal with scary charges for emergency medical transportation, aka ambulances or air ambulances. The nation has a patchwork of private, governmental, and contracted providers for this service with a complex array of expectations and charges, for which patients will still need to be wary.

They also must, for the most part, rely primarily on doctors, hospitals, and other medical providers within their insurer networks, as well as typically seeking approval in advance if possible for expensive procedures or treatments.

Let’s face it, too, as is underscored in a New York Times article on the new law’s taking effect, modern medicine has such nosebleed, mystifying costs that it is a near-impossible task to truly vanquish the “surprise” of the reams of bills that patients get for their care. With most regular folks getting health coverage through their employers, for example, and with workers shouldering big and increasing medical costs with lessened monthly premiums in exchange for burdensome deductibles, patients likely will get ripped still with dizzying medical bills.

Still, patients no doubt will take the financial relief from the terror of unanticipated, unnecessary, hard-to-explain, and sizable medical bills.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of treatments and prescription medications, too many of which turn out to be dangerous drugs.

With the latest economic studies showing that Americans spend more than $4 trillion annually on health care while receiving some of the poorest outcomes among their peers in advanced nations, it is past time for those with the power to effect change to reckon with the unaffordable, unsustainable costs of U.S. medicine. Health care in the wealthiest nation in the world must be a right, not a privilege.

We have a lot of work to do to ensure that patients don’t get trampled by payers and providers trying to maximize a buck for themselves, and we need the whole health care system to be not only far more accessible, affordable, but also transparent. Too many hospitals have failed to provide data on their charges and price deals, as recent federal laws require. The studies of the information that has emerged, alas, only underscore the odious suspicion that payers and providers in health care set arbitrary prices determined not by reality but mostly by what the market — suffering patients, and especially the poor — can bear. This is not good and needs major change

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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