Starting Jan. 1, 2022, out-of-network clinical laboratories may no longer be allowed to bill patients for lab tests performed in certain settings under a law both houses of Congress passed on Dec. 21.
The COVID relief bill includes a ban on unexpected medical bills from some out-of-network providers, such as clinical laboratories, anatomic pathologists, anesthesiologists, and emergency room physicians. Included in the legislation is The No Surprises Act, which would ban balance billing from out-of-network medical providers for amounts those patients’ insurers do not cover.
Designed to stimulate the economy, this comprehensive bill also includes short-term unemployment benefits and $600 direct payments to individuals. However, the president had conditions he wanted met before he agreed to sign the bill into law, The Washington Post reported on Dec. 26.
“Starting in 2022, when the law goes into effect, consumers won’t get balance bills when they seek emergency care, when they are transported by an air ambulance, or when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory,” Kaiser Health News (KHN) reported.
Instead, patients would pay only the deductibles and copayment amounts that they would normally pay for in-network care under their health plan. “Medical providers won’t be allowed to hold patients responsible for the difference between those amounts and the higher fees they might like to charge,” KHN wrote.
Clinical labs and AP groups that still have payment disputes with consumers would need to negotiate acceptable terms with insurers. For those who are uninsured or get all of their care out of network, the bill requires the federal Department of Health and Human Services to establish a provider-patient bill dispute resolution process, KHN reported.
Most patients may not know when they get a lab test or AP procedure from an out-of-network provider, especially if they get care at an in-network hospital. When seeking emergency or urgent care, patients have little choice and may assume they are getting in-network care.
“The legislative agreement also applies to nonemergency care provided at in-network facilities, where patients receive care and services from out-of-network providers, such as anesthesiologists and laboratories,” KHN noted.
In some situations, physicians, but not all providers, would be allowed to balance-bill patients if they get patient consent in advance. Providers would need to provide a cost estimate and get consent at least 72 hours before treatment. For shorter-turnaround times, the new law says patients should get the consent information when they make the appointment, KHN reported.
Clinical laboratories, pathologists, radiologists, neonatologists, and assistant surgeons, however, would not be allowed to seek consent to balance-bill for their services. What’s more, the legislation allows the consent-seeking process only in nonemergency circumstances.