Biden administration announces rule on implementing ban on ‘surprise’ medical billing

The Biden administration on Thursday released a rule for how health care providers and insurers should implement legislation prohibiting what are known as surprise medical bills.

The rule outlines procedures for how disagreements between payers and providers over out-of-network rates should be resolved, provides self-paying and uninsured people a way to resolve payment disputes and provides a process for resolving payment disputes without placing patients in the middle, among other features.

The regulations outline an arbitration process among insurance providers and a service provider who are at odds over payment, allowing a negotiation process of 30 days to be initiated by either the insurance company or provider to try to resolve the dispute, The Associated Press reported. If that process fails to reach a resolution, an independent third-party can be asked to arbitrate.

The rule applies to the bipartisan legislation passed last December, known as the No Surprise Act. It is intended to prevent surprise medical bills and is slated to go into effect Jan. 1. Former President Trump signed the bill into law and the Biden administration has since then been working on crafting its regulations.

The regulations announced by the Biden administration are aimed at trying to combat higher-than-expected medical costs and penalizing patients who unexpectedly contract out-of-network expenses. 

“No one should have to go bankrupt over a surprise medical bill,” Health and Human Services Secretary Xavier Becerra said in a statement. “With today’s rule, we continue to deliver on President Biden’s Competition Executive Order by promoting price transparency and exposing inflated health care costs. Our goal is simple: giving Americans a better deal from a more competitive health care system.”