New interim rule takes aim at surprise medical bills

The rule would restrict excessive out-of-pocket patient costs from surprise and balance billing.

The Department of Health and Human Services (HHS) has announced an interim rule aimed at restricting hefty out-of-pocket patient costs due to surprise and balance billing.

According to a news release, HHS and the Office of Personnel Management have issued the interim final rule, "Requirements Related to Surprise Billing; Part I," will extend Medicare and Medicaid protections against surprise and balance billing to employer-sponsored and commercial health plans.

"No patient should forgo care for fear of surprise billing," HHS Secretary Xavier Becerra says in the release. "Health insurance should offer patients peace of mind that they won't be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises."

Some of the provisions of the interim final rule include:

  • A ban on surprise billing for emergency services by requiring them to be treated on an in-network basis without prior authorization requirements.
  • A ban on high out-of-network cost-sharing for both emergency and non-emergency care by limiting coinsurance or deductibles from being higher than of the physician were in-network.
  • A full ban on out-of-network charges for ancillary care at an in-network facility.
  • A ban on out-of-network charges without the health care provider or facility providing patients a plain language notice explaining that consent is required to receive out-of-network care before the patient can be billed at the higher rate.

The goal of these provisions is to give patients financial peace of mind when they seek emergency care and safeguarding them from unknowingly accepting out-of-network care and surprise bills, according to the release.

"No one should ever be threatened with financial ruin simply for seeking needed medical care," Secretary of Labor Marty Walsh says in the release. "Today's Interim Final Rule is a major step in implementing the bipartisan No Surprises Act that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers."