Biden officials release first rules implementing ban on surprise medical bills

The Biden administration on Thursday issued the first regulations to implement a major law passed by Congress last year to protect patients from massive, “surprise” medical bills. 

The new regulation, which will go into effect Jan. 1, implements provisions protecting patients from getting stuck with bills for thousands of dollars when a doctor happens to be outside their insurance network. 

The rules apply to both emergency room care, as well as non-emergency situations, like when an anesthesiologist happens to be out-of-network even though the surgeon is in-network. 

Secretary of Health and Human Services Xavier Becerra said the protections “probably only second to the Affordable Care Act will make a major difference in the lives, the health care, of millions of Americans.”

The rules stem from the bipartisan No Surprises Act, which Congress passed in December and was signed into law by former President Trump as part of a massive funding package. That law was the product of months of tense negotiations. 

The issue has also set off fierce lobbying, with employers and insurers on one side and hospitals and doctors on the other side trying to shape the regulations, concerned about how much the insurer will have to pay the doctor once patients are protected. 

The law gives many of those decisions to an outside arbiter to determine payment amounts, and many of the closely-watched details of that arbitration process are still to come in future regulations. 

One employer group, the ERISA Industry Committee, was happy with the regulations Thursday.  

“Because of the strong regulations released today, January of 2022 will mark the end, once and for all, of these predatory billing practices – and will do so without burdening patients with higher health insurance premiums,” said James Gelfand, the group’s senior vice president of health policy.